Provider Demographics
NPI:1447230628
Name:VERVAET, KERI JO (OD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:JO
Last Name:VERVAET
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 CHANDON WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-8049
Mailing Address - Country:US
Mailing Address - Phone:303-681-1133
Mailing Address - Fax:
Practice Address - Street 1:9330 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5065
Practice Address - Country:US
Practice Address - Phone:303-346-8400
Practice Address - Fax:303-346-1785
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01532553Medicaid
COCO304346Medicare PIN