Provider Demographics
NPI:1518182351
Name:DINNEBECK, JAMES DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:DINNEBECK
Suffix:
Gender:M
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:1815 65TH AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7964
Mailing Address - Country:US
Mailing Address - Phone:970-330-7200
Mailing Address - Fax:970-330-7201
Practice Address - Street 1:1815 65TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7964
Practice Address - Country:US
Practice Address - Phone:970-330-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0001553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist