Provider Demographics
NPI:1396821146
Name:GRUPE, IVAN J (OD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:J
Last Name:GRUPE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8586 E ARAPAHOE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1433
Mailing Address - Country:US
Mailing Address - Phone:303-771-4221
Mailing Address - Fax:303-721-7759
Practice Address - Street 1:8586 E ARAPAHOE RD
Practice Address - Street 2:STE 100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1433
Practice Address - Country:US
Practice Address - Phone:303-771-4221
Practice Address - Fax:303-721-7759
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO738152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU19149Medicare UPIN
32344YMRBMedicare PIN