Provider Demographics
NPI:1568580421
Name:ROSE, MARCY (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:
Last Name:ROSE
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 1:10359 FEDERAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-7452
Mailing Address - Country:US
Mailing Address - Phone:303-469-7770
Mailing Address - Fax:
Practice Address - Street 1:10359 FEDERAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80260-7452
Practice Address - Country:US
Practice Address - Phone:303-469-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 1240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO801568Medicare ID - Type Unspecified
COU19779Medicare UPIN