Provider Demographics
NPI:1710942321
Name:WAZNY, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:WAZNY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:3190 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4899
Mailing Address - Country:US
Mailing Address - Phone:303-988-5858
Mailing Address - Fax:303-988-3651
Practice Address - Street 1:3190 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4899
Practice Address - Country:US
Practice Address - Phone:303-988-5858
Practice Address - Fax:303-988-3651
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0357460001Medicare NSC