Provider Demographics
NPI:1629417175
Name:COLPITT, JESSICA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:COLPITT
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 1:8586 E ARAPAHOE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1433
Mailing Address - Country:US
Mailing Address - Phone:303-771-4221
Mailing Address - Fax:303-721-7759
Practice Address - Street 1:8586 E ARAPAHOE RD STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1433
Practice Address - Country:US
Practice Address - Phone:303-771-4221
Practice Address - Fax:303-721-7759
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2770152W00000X
AR2690152W00000X
CO3096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
310504YQ5QMedicare PIN