Provider Demographics
NPI:1952512378
Name:OPTICAS LUX
Entity Type:Organization
Organization Name:OPTICAS LUX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-570-2595
Mailing Address - Street 1:414 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3404
Mailing Address - Country:US
Mailing Address - Phone:720-570-2595
Mailing Address - Fax:720-570-2770
Practice Address - Street 1:414 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3404
Practice Address - Country:US
Practice Address - Phone:720-570-2595
Practice Address - Fax:720-570-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site