Provider Demographics
NPI:1801820469
Name:LOOK OPTICAL, PC
Entity Type:Organization
Organization Name:LOOK OPTICAL, PC
Other - Org Name:LOOK OPTICAL (WEST 44TH ST - 1760046015)
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSUR
Authorized Official - Middle Name:
Authorized Official - Last Name:NURDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-808-3112
Mailing Address - Street 1:5790 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7340
Mailing Address - Country:US
Mailing Address - Phone:303-421-4422
Mailing Address - Fax:
Practice Address - Street 1:5790 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7340
Practice Address - Country:US
Practice Address - Phone:303-421-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22176071Medicaid
COC474658Medicare PIN
CO5130420003Medicare NSC