Provider Demographics
NPI:1285643023
Name:DENVER EYE CENTER OPTICAL
Entity Type:Organization
Organization Name:DENVER EYE CENTER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-279-2600
Mailing Address - Street 1:13772 DENVER WEST PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3139
Mailing Address - Country:US
Mailing Address - Phone:303-279-2600
Mailing Address - Fax:303-273-8790
Practice Address - Street 1:13772 DENVER WEST PARKWAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3139
Practice Address - Country:US
Practice Address - Phone:303-279-2600
Practice Address - Fax:303-273-8790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO227111000000332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04510087Medicaid
CO0326880001Medicare NSC
G39556Medicare UPIN
E67541Medicare UPIN
U58113Medicare UPIN
D22998Medicare UPIN
I15854Medicare UPIN
CO04510087Medicaid