Provider Demographics
NPI:1518352699
Name:SIMPLE OPTICAL, INC.
Entity Type:Organization
Organization Name:SIMPLE OPTICAL, INC.
Other - Org Name:GUNBARREL OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-530-1973
Mailing Address - Street 1:6545 GUNPARK DR
Mailing Address - Street 2:STE 250
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3347
Mailing Address - Country:US
Mailing Address - Phone:303-530-1973
Mailing Address - Fax:303-530-1973
Practice Address - Street 1:6545 GUNPARK DR
Practice Address - Street 2:STE 250
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3347
Practice Address - Country:US
Practice Address - Phone:303-530-1973
Practice Address - Fax:720-638-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO406813Medicare PIN