Provider Demographics
NPI:1326485673
Name:STAPLETON FAMILY OPTICAL LLC
Entity Type:Organization
Organization Name:STAPLETON FAMILY OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEYKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-463-5792
Mailing Address - Street 1:4875 WARD RD STE 600
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1944
Mailing Address - Country:US
Mailing Address - Phone:303-463-5792
Mailing Address - Fax:303-467-0145
Practice Address - Street 1:2373 CENTRAL PARK BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2300
Practice Address - Country:US
Practice Address - Phone:303-463-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier