Provider Demographics
NPI:1043716269
Name:GRABER, MADELINE ALENE (OD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ALENE
Last Name:GRABER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:ALENE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 E HAMPDEN AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2518
Mailing Address - Country:US
Mailing Address - Phone:303-482-1300
Mailing Address - Fax:303-482-1356
Practice Address - Street 1:180 E HAMPDEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2518
Practice Address - Country:US
Practice Address - Phone:303-482-1300
Practice Address - Fax:303-482-1356
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000174604Medicaid