Provider Demographics
NPI:1568452563
Name:BELL, JERRY MICHAEL (O D)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:MICHAEL
Last Name:BELL
Suffix:
Gender:M
Credentials:O D
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:10371 S PARK GLENN WAY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3869
Mailing Address - Country:US
Mailing Address - Phone:303-840-6268
Mailing Address - Fax:303-840-5385
Practice Address - Street 1:9235 CROWN CREST BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138
Practice Address - Country:US
Practice Address - Phone:303-840-6268
Practice Address - Fax:303-840-5385
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2113152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93055773Medicaid
COF2973Medicare ID - Type Unspecified
COU811629Medicare UPIN