Provider Demographics
NPI:1568574739
Name:SMITH, CAROLYN JANE (OD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3900 E MEXICO AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3940
Mailing Address - Country:US
Mailing Address - Phone:720-524-1001
Mailing Address - Fax:720-524-1121
Practice Address - Street 1:1255 19TH ST
Practice Address - Street 2:STE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1459
Practice Address - Country:US
Practice Address - Phone:720-524-1001
Practice Address - Fax:720-524-1121
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2062OtherSTATE LICENSE
COU83452Medicare UPIN