Provider Demographics
NPI:1639745748
Name:LEEANN TYRRELL OD LLC
Entity Type:Organization
Organization Name:LEEANN TYRRELL OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TYRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-818-2479
Mailing Address - Street 1:18451 W 58TH CT
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-2157
Mailing Address - Country:US
Mailing Address - Phone:303-818-2479
Mailing Address - Fax:303-280-6757
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:303-280-0971
Practice Address - Fax:303-280-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-29
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center