Provider Demographics
NPI:1821107632
Name:EMPIRE OPTICAL CO
Entity Type:Organization
Organization Name:EMPIRE OPTICAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:GILTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-512-0177
Mailing Address - Street 1:1485 S COLORADO BLVD
Mailing Address - Street 2:#260
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3619
Mailing Address - Country:US
Mailing Address - Phone:303-512-0177
Mailing Address - Fax:303-759-9375
Practice Address - Street 1:1485 S COLORADO BLVD
Practice Address - Street 2:#260
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3619
Practice Address - Country:US
Practice Address - Phone:303-512-0177
Practice Address - Fax:303-759-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
7779-3Medicare ID - Type Unspecified