Provider Demographics
NPI:1477856425
Name:DR. SHAWN COTTRELL O.D., P.C.
Entity Type:Organization
Organization Name:DR. SHAWN COTTRELL O.D., P.C.
Other - Org Name:ARVADA OPTOMETRIC CENTER P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-424-5282
Mailing Address - Street 1:7913 ALLISON WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-5032
Mailing Address - Country:US
Mailing Address - Phone:303-424-5282
Mailing Address - Fax:303-424-8291
Practice Address - Street 1:7913 ALLISON WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-5032
Practice Address - Country:US
Practice Address - Phone:303-424-5282
Practice Address - Fax:303-424-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA105236Medicare PIN