Provider Demographics
NPI:1194864801
Name:ISRAELSON, JEAN BERKEY (OD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:BERKEY
Last Name:ISRAELSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4806
Mailing Address - Country:US
Mailing Address - Phone:303-939-8021
Mailing Address - Fax:303-939-8025
Practice Address - Street 1:1230 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4806
Practice Address - Country:US
Practice Address - Phone:303-939-8021
Practice Address - Fax:303-939-8025
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2280152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU89729Medicare UPIN
CO454958Medicare ID - Type Unspecified