Provider Demographics
NPI:1083701627
Name:MOLINARIO, JOHN A (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MOLINARIO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2178 CAPE HATTERAS DR UNIT 10
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-7229
Mailing Address - Country:US
Mailing Address - Phone:970-430-4498
Mailing Address - Fax:970-833-5510
Practice Address - Street 1:1015 SO TAFT HILL RD #J
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521
Practice Address - Country:US
Practice Address - Phone:970-482-6034
Practice Address - Fax:970-484-4146
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-04-03
Deactivation Date:2020-03-03
Deactivation Code:
Reactivation Date:2020-04-03
Provider Licenses
StateLicense IDTaxonomies
CO1171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62821547Medicaid
CO62821547Medicaid