Provider Demographics
NPI:1467638684
Name:PAULASKAS, ANNETTE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MARIE
Last Name:PAULASKAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:ANNETTE
Other - Last Name:PAULASKAS-LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3886 E 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2548
Mailing Address - Country:US
Mailing Address - Phone:303-254-6690
Mailing Address - Fax:
Practice Address - Street 1:4759 W 29TH ST
Practice Address - Street 2:UNIT C
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8380
Practice Address - Country:US
Practice Address - Phone:970-339-0087
Practice Address - Fax:970-339-5685
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist