Provider Demographics
NPI:1720223647
Name:DR. SCOTTS OPTICAL #2
Entity Type:Organization
Organization Name:DR. SCOTTS OPTICAL #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GOETTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-237-6694
Mailing Address - Street 1:98 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1550
Mailing Address - Country:US
Mailing Address - Phone:303-237-6694
Mailing Address - Fax:303-237-3347
Practice Address - Street 1:98 WADSWORTH BLVD
Practice Address - Street 2:SUITE 122
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1550
Practice Address - Country:US
Practice Address - Phone:303-237-6694
Practice Address - Fax:303-237-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25-44623-0000332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier