Provider Demographics
NPI:1821263971
Name:DR THOMAS POLITZER OD PC
Entity Type:Organization
Organization Name:DR THOMAS POLITZER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLIZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-989-2020
Mailing Address - Street 1:333 S ALLISON PARKWAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3115
Mailing Address - Country:US
Mailing Address - Phone:303-989-2020
Mailing Address - Fax:303-980-5283
Practice Address - Street 1:333 S ALLISON PARKWAY
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3115
Practice Address - Country:US
Practice Address - Phone:303-989-2020
Practice Address - Fax:303-980-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020343Medicaid
COU12612Medicare UPIN
CO04020343Medicaid
CO354999Medicare PIN