Provider Demographics
NPI:1699177840
Name:MACIEJEWSKI, CAITLIN (OD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:MACIEJEWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 COMMUNICATION CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1744
Mailing Address - Country:US
Mailing Address - Phone:719-596-2020
Mailing Address - Fax:719-465-2625
Practice Address - Street 1:7685 MCLAUGHLIN RD STE 130
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4751
Practice Address - Country:US
Practice Address - Phone:719-886-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003067152W00000X
CO0003067152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist