Provider Demographics
NPI:1154099174
Name:GLAUCOMA CONSULTANTS OF COLORADO, PC
Entity Type:Organization
Organization Name:GLAUCOMA CONSULTANTS OF COLORADO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-794-1111
Mailing Address - Street 1:11960 LIONESS WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5640
Mailing Address - Country:US
Mailing Address - Phone:303-794-1111
Mailing Address - Fax:
Practice Address - Street 1:11961 LIONESS WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5302
Practice Address - Country:US
Practice Address - Phone:303-794-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty