Provider Demographics
NPI:1588855035
Name:TIM W. JAMES OD PC
Entity Type:Organization
Organization Name:TIM W. JAMES OD PC
Other - Org Name:KEN-CARYL VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:W
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PC
Authorized Official - Phone:303-973-1948
Mailing Address - Street 1:6179 S BALSAM WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3092
Mailing Address - Country:US
Mailing Address - Phone:303-973-1948
Mailing Address - Fax:
Practice Address - Street 1:6179 S BALSAM WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3092
Practice Address - Country:US
Practice Address - Phone:303-973-1948
Practice Address - Fax:303-904-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 2219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1588855035OtherMEDICARE NPI
CO1588855035OtherMEDICARE NPI
COC461698Medicare PIN