Provider Demographics
NPI:1194862862
Name:MUNSON, MITCHELL TODD (OD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:TODD
Last Name:MUNSON
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 1:8925 RIDGELINE BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2502
Mailing Address - Country:US
Mailing Address - Phone:303-791-2727
Mailing Address - Fax:303-791-2529
Practice Address - Street 1:8925 RIDGELINE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2502
Practice Address - Country:US
Practice Address - Phone:303-791-2727
Practice Address - Fax:303-791-2529
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1320OtherSTATE LICENSE NUMBER
CO1320OtherSTATE LICENSE NUMBER
COT93317Medicare UPIN