Provider Demographics
NPI:1639109234
Name:MCHUGH, MARLA R (OD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:R
Last Name:MCHUGH
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 1:1097 LEYDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4636
Mailing Address - Country:US
Mailing Address - Phone:303-322-5322
Mailing Address - Fax:
Practice Address - Street 1:1399 S HAVANA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4020
Practice Address - Country:US
Practice Address - Phone:303-750-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU84075Medicare UPIN
CO424688Medicare ID - Type Unspecified