Provider Demographics
NPI:1336262393
Name:DOCKINS, AUDREY LOIS (OD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LOIS
Last Name:DOCKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3313
Mailing Address - Country:US
Mailing Address - Phone:719-597-6987
Mailing Address - Fax:719-597-7190
Practice Address - Street 1:1315 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3313
Practice Address - Country:US
Practice Address - Phone:719-597-6987
Practice Address - Fax:719-597-7190
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO2264152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU89419Medicare UPIN