Provider Demographics
NPI:1487656146
Name:COLVIN, JOHN W (OD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:COLVIN
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 1:3650 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8701
Mailing Address - Country:US
Mailing Address - Phone:970-669-1107
Mailing Address - Fax:970-669-8849
Practice Address - Street 1:3650 E 15TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8701
Practice Address - Country:US
Practice Address - Phone:970-669-1107
Practice Address - Fax:970-669-8849
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99143599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO905025020761OtherEYE SPECIALISTS
CO8014359Medicaid
COT97142Medicare UPIN
COP00065582Medicare PIN
CO0714010001Medicare NSC
CO8014359Medicaid
180011949Medicare PIN