Provider Demographics
NPI:1437132073
Name:CRIST, DAVID SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:CRIST
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 1:2741 S COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6601
Mailing Address - Country:US
Mailing Address - Phone:303-757-3311
Mailing Address - Fax:303-757-3692
Practice Address - Street 1:2741 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6601
Practice Address - Country:US
Practice Address - Phone:303-757-3311
Practice Address - Fax:303-757-3692
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO0750OtherBLUE CROSS BLUE SHIELD
CO0258040001Medicare NSC
COC805380Medicare PIN
COC805381Medicare PIN
COCO0750OtherBLUE CROSS BLUE SHIELD