Provider Demographics
NPI:1447392543
Name:WOLFORD, JANE L (OD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:WOLFORD
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 1:800 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5928
Mailing Address - Country:US
Mailing Address - Phone:303-772-6140
Mailing Address - Fax:303-772-9128
Practice Address - Street 1:800 3RD AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5928
Practice Address - Country:US
Practice Address - Phone:303-772-6140
Practice Address - Fax:303-772-9128
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5816400001Medicare NSC
COC807431Medicare UPIN