Provider Demographics
NPI:1760674162
Name:WAKEFIELD, LEO KEN
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:KEN
Last Name:WAKEFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 E 2ND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4924
Mailing Address - Country:US
Mailing Address - Phone:303-322-7507
Mailing Address - Fax:
Practice Address - Street 1:100 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4916
Practice Address - Country:US
Practice Address - Phone:303-321-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician