Provider Demographics
NPI:1134374945
Name:CREATIVE EYEWEAR LLC
Entity type:Organization
Organization Name:CREATIVE EYEWEAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:PRACTICE ADMIN
Authorized Official - Phone:303-421-8990
Mailing Address - Street 1:8850 RALSTON RD
Mailing Address - Street 2:#100
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2252
Mailing Address - Country:US
Mailing Address - Phone:303-421-8990
Mailing Address - Fax:303-421-9402
Practice Address - Street 1:8850 RALSTON RD
Practice Address - Street 2:#100
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2252
Practice Address - Country:US
Practice Address - Phone:303-421-8990
Practice Address - Fax:303-421-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO2534332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1013027291OtherNPI OPTOMETRIST
COCO2534OtherCOLORADO LISCENCE #
COCO2534OtherCOLORADO LISCENCE #
COMP1473076OtherDEA #