Provider Demographics
NPI:1740412121
Name:PEDROZA, DEANNA MONIQUE (OD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MONIQUE
Last Name:PEDROZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13142 GRANT CIR N
Mailing Address - Street 2:UNIT B
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3498
Mailing Address - Country:US
Mailing Address - Phone:720-217-7644
Mailing Address - Fax:
Practice Address - Street 1:550 THORNTON PKWY
Practice Address - Street 2:SUITE # 222
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2100
Practice Address - Country:US
Practice Address - Phone:303-920-3937
Practice Address - Fax:719-542-0425
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist