Provider Demographics
NPI:1083607345
Name:DEMAYO, EUGENE FRANK (OD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:FRANK
Last Name:DEMAYO
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 1:3121 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1315
Mailing Address - Country:US
Mailing Address - Phone:303-938-1500
Mailing Address - Fax:303-938-9458
Practice Address - Street 1:3121 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1315
Practice Address - Country:US
Practice Address - Phone:303-938-1500
Practice Address - Fax:303-938-9458
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1160152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC42253Medicare ID - Type Unspecified