Provider Demographics
NPI:1710474143
Name:CARROLL, JILL KATHRYN (COT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:KATHRYN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:COT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CANYON CEDAR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3531
Mailing Address - Country:US
Mailing Address - Phone:720-982-3961
Mailing Address - Fax:
Practice Address - Street 1:10 CANYON CEDAR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-3531
Practice Address - Country:US
Practice Address - Phone:720-982-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84407207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology