Provider Demographics
NPI:1144805334
Name:SIMPLE OPTICAL, INC.
Entity Type:Organization
Organization Name:SIMPLE OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-887-6066
Mailing Address - Street 1:520 ZANG ST STE I
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8235
Mailing Address - Country:US
Mailing Address - Phone:720-887-6066
Mailing Address - Fax:720-887-5866
Practice Address - Street 1:520 ZANG ST STE I
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8235
Practice Address - Country:US
Practice Address - Phone:720-887-6066
Practice Address - Fax:720-887-5866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLE OPTICAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty