Provider Demographics
NPI:1013094689
Name:GODFREY, KENT RAMSEY (OD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:RAMSEY
Last Name:GODFREY
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 1:4920 S YOSEMITE ST STE C5
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1352
Mailing Address - Country:US
Mailing Address - Phone:303-220-5100
Mailing Address - Fax:303-220-5938
Practice Address - Street 1:4920 S YOSEMITE ST STE C5
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1352
Practice Address - Country:US
Practice Address - Phone:303-220-5100
Practice Address - Fax:303-220-5938
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOP2560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807104Medicare PIN