Provider Demographics
NPI:1083984686
Name:DANZO, MARK S (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:DANZO
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 1:400 INVERNESS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5830
Mailing Address - Country:US
Mailing Address - Phone:303-768-9192
Mailing Address - Fax:
Practice Address - Street 1:400 INVERNESS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5830
Practice Address - Country:US
Practice Address - Phone:303-768-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist