Provider Demographics
NPI:1811024383
Name:MIGUES, GARY (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:MIGUES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 WEWATTA ST
Mailing Address - Street 2:UNIT 812
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1257
Mailing Address - Country:US
Mailing Address - Phone:303-704-0784
Mailing Address - Fax:
Practice Address - Street 1:130 NINTH STREET
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80477
Practice Address - Country:US
Practice Address - Phone:970-879-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 1607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO1607OtherEYEMED
COC801588Medicare ID - Type Unspecified
COW49272Medicare UPIN