Provider Demographics
NPI:1881633352
Name:ROFFIS, C. JACK (OD)
Entity Type:Individual
Prefix:DR
First Name:C. JACK
Middle Name:
Last Name:ROFFIS
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 1:6165 SIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-3007
Mailing Address - Country:US
Mailing Address - Phone:303-499-5823
Mailing Address - Fax:303-499-5823
Practice Address - Street 1:1933 28TH ST
Practice Address - Street 2:STE. 206
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1100
Practice Address - Country:US
Practice Address - Phone:303-447-8470
Practice Address - Fax:303-443-9555
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1277152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU31785Medicare UPIN
CO41663Medicare ID - Type Unspecified