Provider Demographics
NPI:1043306988
Name:DANG, BICKLY (OD)
Entity Type:Individual
Prefix:DR
First Name:BICKLY
Middle Name:
Last Name:DANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 E 100TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2364
Mailing Address - Country:US
Mailing Address - Phone:303-451-1999
Mailing Address - Fax:
Practice Address - Street 1:1685 S COLORADO BLVD
Practice Address - Street 2:UNIT O
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4000
Practice Address - Country:US
Practice Address - Phone:303-757-6747
Practice Address - Fax:303-757-6897
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2209152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01554522Medicaid
CO450008Medicare ID - Type Unspecified
COU89057Medicare UPIN