Provider Demographics
NPI:1235122045
Name:HIMEL, DAVID WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:HIMEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:W
Other - Last Name:HIMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1280 CENTAUR VILLAGE DR
Mailing Address - Street 2:STE 2
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3175
Mailing Address - Country:US
Mailing Address - Phone:303-604-1060
Mailing Address - Fax:720-890-8153
Practice Address - Street 1:1407 W 84TH AVE UNIT B8
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-4753
Practice Address - Country:US
Practice Address - Phone:720-214-4746
Practice Address - Fax:720-214-4745
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMH0193514207W00000X
COOPT.0001403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOPT.0001403OtherSTATE LICENSE
CO9000107459Medicaid
CO9000107459Medicaid