Provider Demographics
NPI:1174655997
Name:LODO OPTICAL
Entity Type:Organization
Organization Name:LODO OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-299-9473
Mailing Address - Street 1:1435 WAZEE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1491
Mailing Address - Country:US
Mailing Address - Phone:303-299-9473
Mailing Address - Fax:303-299-9472
Practice Address - Street 1:1435 WAZEE ST STE 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1491
Practice Address - Country:US
Practice Address - Phone:303-299-9473
Practice Address - Fax:303-299-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07-70541-0000332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO4853OtherEYEMED