Provider Demographics
NPI:1669637716
Name:DR. STEPHEN KESSELMAN MD PC
Entity Type:Organization
Organization Name:DR. STEPHEN KESSELMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-751-1272
Mailing Address - Street 1:1550 S POTOMAC ST
Mailing Address - Street 2:#240
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5455
Mailing Address - Country:US
Mailing Address - Phone:303-751-1272
Mailing Address - Fax:303-751-5850
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:#240
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-751-1272
Practice Address - Fax:303-751-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC49251Medicare UPIN