Provider Demographics
NPI:1942516646
Name:STURM, MARYN CAPRICE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARYN
Middle Name:CAPRICE
Last Name:STURM
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 1:215 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-3428
Mailing Address - Country:US
Mailing Address - Phone:970-454-3387
Mailing Address - Fax:
Practice Address - Street 1:215 ELM AVE
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-3428
Practice Address - Country:US
Practice Address - Phone:970-454-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist