Provider Demographics
NPI:1376733709
Name:COTTRELL, SHAWN RYAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:RYAN
Last Name:COTTRELL
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 1:14500 W COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3203
Mailing Address - Country:US
Mailing Address - Phone:303-273-9953
Mailing Address - Fax:303-273-9955
Practice Address - Street 1:14500 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3203
Practice Address - Country:US
Practice Address - Phone:303-273-9953
Practice Address - Fax:303-273-9955
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist