Provider Demographics
NPI:1750468062
Name:SLOSAR, MARK A (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SLOSAR
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10608 CLARKEVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9146
Mailing Address - Country:US
Mailing Address - Phone:949-310-9926
Mailing Address - Fax:
Practice Address - Street 1:720 S COLORADO BLVD STE 140A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1916
Practice Address - Country:US
Practice Address - Phone:303-607-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6809T152W00000X
TX7351T152W00000X
CO2837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063727790OtherORGANIZATIONAL NPI
CAT10416Medicare UPIN