Provider Demographics
NPI:1659419836
Name:SPRINGSTON, JAMES R (O D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:SPRINGSTON
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2125
Mailing Address - Country:US
Mailing Address - Phone:720-261-2699
Mailing Address - Fax:
Practice Address - Street 1:3301 TOWER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-3509
Practice Address - Country:US
Practice Address - Phone:720-374-8477
Practice Address - Fax:720-374-8821
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0800934Medicaid
CO0800934Medicaid
CO454848Medicare ID - Type Unspecified