Provider Demographics
NPI:1518189943
Name:OPTIK SHOPPE INC
Entity Type:Organization
Organization Name:OPTIK SHOPPE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BURCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-340-4600
Mailing Address - Street 1:4 WALDEN LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2044
Mailing Address - Country:US
Mailing Address - Phone:303-694-1151
Mailing Address - Fax:
Practice Address - Street 1:750 POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6700
Practice Address - Country:US
Practice Address - Phone:303-364-1548
Practice Address - Fax:303-364-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE82849Medicare UPIN
CO0262160001Medicare ID - Type Unspecified