Provider Demographics
NPI:1558406611
Name:MOK, AMY (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:MOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 W. COLFAX AVE
Mailing Address - Street 2:SUITE #309
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3229
Mailing Address - Country:US
Mailing Address - Phone:303-278-4191
Mailing Address - Fax:303-271-0433
Practice Address - Street 1:14500 W. COLFAX AVE
Practice Address - Street 2:SUITE #309
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3229
Practice Address - Country:US
Practice Address - Phone:303-278-4191
Practice Address - Fax:303-271-0433
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV373152W00000X
CO3237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDM339ZOtherPTAN