Provider Demographics
NPI:1043496292
Name:WOLFLEY, TODD L (OD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:L
Last Name:WOLFLEY
Suffix:
Gender:M
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-0209
Mailing Address - Country:US
Mailing Address - Phone:970-522-4396
Mailing Address - Fax:
Practice Address - Street 1:419 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3033
Practice Address - Country:US
Practice Address - Phone:970-522-4396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08014227Medicaid
CO08014227Medicaid
COU20975Medicare UPIN