Provider Demographics
NPI:1184292385
Name:HOWARD, DEREK MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:MICHAEL
Last Name:HOWARD
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 1:7286 PINE HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-8999
Mailing Address - Country:US
Mailing Address - Phone:720-229-9255
Mailing Address - Fax:
Practice Address - Street 1:2301 PRAIRIE CENTER PKWY UNIT A
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-7023
Practice Address - Country:US
Practice Address - Phone:720-685-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty