Provider Demographics
NPI:1447234661
Name:TOMOEDA, ALLEN KOICHI (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:KOICHI
Last Name:TOMOEDA
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 1:6201 S AURORA PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5849
Mailing Address - Country:US
Mailing Address - Phone:303-617-5620
Mailing Address - Fax:303-617-5622
Practice Address - Street 1:6201 S AURORA PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5849
Practice Address - Country:US
Practice Address - Phone:303-617-5620
Practice Address - Fax:303-617-5622
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9993899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08009383Medicaid
CO40763Medicare ID - Type Unspecified
CO08009383Medicaid