Provider Demographics
NPI:1376549055
Name:POND, LINWOOD PAGE (OD)
Entity Type:Individual
Prefix:DR
First Name:LINWOOD
Middle Name:PAGE
Last Name:POND
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 1:15320 E ALAMEDA PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-2066
Mailing Address - Country:US
Mailing Address - Phone:303-745-9400
Mailing Address - Fax:
Practice Address - Street 1:15320 E ALAMEDA PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-2066
Practice Address - Country:US
Practice Address - Phone:303-745-9400
Practice Address - Fax:303-369-5212
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-03-28
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
COCO1006152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT41004Medicare UPIN
COC78513Medicare PIN