Provider Demographics
NPI:1134353626
Name:ELITE OCULOPLASTIC SURGERY, PC
Entity type:Organization
Organization Name:ELITE OCULOPLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-856-6850
Mailing Address - Street 1:5690 DTC BLVD
Mailing Address - Street 2:SUITE 130W
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-500-5042
Mailing Address - Fax:303-872-6717
Practice Address - Street 1:5690 DTC BLVD
Practice Address - Street 2:SUITE 130W
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-500-5042
Practice Address - Fax:303-872-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45241207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCP2889Medicaid
SCCP2889Medicaid
SC6598Medicare UPIN