Provider Demographics
NPI:1689689374
Name:MICHAEL BOLLENBACHER, OD & ASSOCIATES, PC
Entity Type:Organization
Organization Name:MICHAEL BOLLENBACHER, OD & ASSOCIATES, PC
Other - Org Name:DR. BOLLENBACHER & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLLENBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-444-1405
Mailing Address - Street 1:2525 ARAPAHOE AVE
Mailing Address - Street 2:SUITE E23
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6720
Mailing Address - Country:US
Mailing Address - Phone:303-444-1405
Mailing Address - Fax:303-413-9421
Practice Address - Street 1:2525 ARAPAHOE AVE
Practice Address - Street 2:SUITE E23
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6720
Practice Address - Country:US
Practice Address - Phone:303-444-1405
Practice Address - Fax:303-413-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty