Provider Demographics
NPI:1063653095
Name:KANI, NURDEL AND ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:KANI, NURDEL AND ASSOCIATES, P.C.
Other - Org Name:LOOK OPTICAL, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-421-4422
Mailing Address - Street 1:5790 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7340
Mailing Address - Country:US
Mailing Address - Phone:303-421-4422
Mailing Address - Fax:303-431-1457
Practice Address - Street 1:5790 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7340
Practice Address - Country:US
Practice Address - Phone:303-421-4422
Practice Address - Fax:303-431-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-21
Last Update Date:2009-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1601332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22176071Medicaid