Provider Demographics
NPI:1922281377
Name:NORTHGLENN OPTOMETRIC CENTER, P.C.
Entity Type:Organization
Organization Name:NORTHGLENN OPTOMETRIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-452-5670
Mailing Address - Street 1:10360 MELODY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6046
Mailing Address - Country:US
Mailing Address - Phone:303-452-5670
Mailing Address - Fax:303-452-2006
Practice Address - Street 1:10360 MELODY DR
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80260-6046
Practice Address - Country:US
Practice Address - Phone:303-452-5670
Practice Address - Fax:303-452-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0307120001OtherCIGNA/DMERC
CO08007114Medicaid
COU36319Medicare UPIN
CO08007114Medicaid