Provider Demographics
NPI:1619010881
Name:TYRRELL, LEEANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:
Last Name:TYRRELL
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 1:12491 CLERMONT ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3039
Mailing Address - Country:US
Mailing Address - Phone:720-929-9208
Mailing Address - Fax:
Practice Address - Street 1:1001 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-5711
Practice Address - Country:US
Practice Address - Phone:303-280-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1965152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist