Provider Demographics
NPI:1730133380
Name:STREIFEL, KETTY L (OD)
Entity Type:Individual
Prefix:
First Name:KETTY
Middle Name:L
Last Name:STREIFEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KETTY
Other - Middle Name:C
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:11960 LIONESS WAY
Mailing Address - Street 2:190
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5640
Mailing Address - Country:US
Mailing Address - Phone:303-794-1111
Mailing Address - Fax:303-347-1341
Practice Address - Street 1:11960 LIONESS WAY
Practice Address - Street 2:190
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5640
Practice Address - Country:US
Practice Address - Phone:303-794-1111
Practice Address - Fax:303-347-1341
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO760762560-006OtherROCKY MOUNTAIN HEALTH
COCO303880Medicare PIN