Provider Demographics
NPI:1275501967
Name:MAMALIS, GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:MAMALIS
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 1:255 UNION BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1863
Mailing Address - Country:US
Mailing Address - Phone:303-985-0004
Mailing Address - Fax:303-985-0037
Practice Address - Street 1:255 UNION BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1863
Practice Address - Country:US
Practice Address - Phone:303-985-0004
Practice Address - Fax:303-985-0037
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1316OtherSTATE LICENSE NO
CO1316OtherSTATE LICENSE NO
CO42713Medicare ID - Type Unspecified