Provider Demographics
NPI:1841221884
Name:CARLSON, LINDA (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 SHERIDAN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3347
Mailing Address - Country:US
Mailing Address - Phone:303-404-2020
Mailing Address - Fax:303-404-2097
Practice Address - Street 1:11480 SHERIDAN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-3347
Practice Address - Country:US
Practice Address - Phone:303-404-2020
Practice Address - Fax:303-404-2097
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU55839Medicare UPIN
CO359008Medicare ID - Type UnspecifiedPRACTICE
CO359018Medicare ID - Type UnspecifiedPERSONAL