Provider Demographics
NPI:1629483144
Name:KINCAID, SAMANTHA (OD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KINCAID
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9235 CROWN CREST BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-5800
Mailing Address - Country:US
Mailing Address - Phone:303-840-6268
Mailing Address - Fax:303-840-5385
Practice Address - Street 1:9235 CROWN CREST BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138
Practice Address - Country:US
Practice Address - Phone:303-840-6268
Practice Address - Fax:303-840-5385
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003359152W00000X
CO3359152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist