Provider Demographics
NPI:1730300757
Name:DENVER OPTIC OCULAR PROSTHETICS CO INC
Entity Type:Organization
Organization Name:DENVER OPTIC OCULAR PROSTHETICS CO INC
Other - Org Name:DENVER OPTIC COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-649-9494
Mailing Address - Street 1:14 INVERNESS DRIVE EAST
Mailing Address - Street 2:BUILDING D SUITE 146
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-649-9494
Mailing Address - Fax:303-790-4055
Practice Address - Street 1:14 INVERNESS DRIVE EAST
Practice Address - Street 2:BUILDING D SUITE 146
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-649-9494
Practice Address - Fax:303-790-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08759136Medicaid
CO08759136Medicaid