Provider Demographics
NPI:1437195708
Name:ROOS, DEBORAH FITZGERALD (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:FITZGERALD
Last Name:ROOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5555 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2312
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08012810Medicaid
CO11219646OtherCAQH ID
COD2623Medicare ID - Type Unspecified
CO08012810Medicaid