Provider Demographics
NPI:1689630097
Name:SIKORSKI, JEFFREY J (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:SIKORSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 BOLEYN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-5382
Mailing Address - Country:US
Mailing Address - Phone:719-598-2900
Mailing Address - Fax:
Practice Address - Street 1:5474 TOMAH DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1928
Practice Address - Country:US
Practice Address - Phone:719-598-2900
Practice Address - Fax:719-264-0766
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU93632Medicare UPIN
CO484468Medicare PIN