Provider Demographics
NPI:1477126654
Name:SIMPLE OPTICAL, INC
Entity Type:Organization
Organization Name:SIMPLE OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-530-1973
Mailing Address - Street 1:6545 GUNPARK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3350
Mailing Address - Country:US
Mailing Address - Phone:303-530-1973
Mailing Address - Fax:720-638-1223
Practice Address - Street 1:5026 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7329
Practice Address - Country:US
Practice Address - Phone:303-756-5900
Practice Address - Fax:303-756-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty