Provider Demographics
NPI:1336711662
Name:TOLEDO, YUBISELA (OD)
Entity Type:Individual
Prefix:
First Name:YUBISELA
Middle Name:
Last Name:TOLEDO
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 1:2438 RESEARCH PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1094
Mailing Address - Country:US
Mailing Address - Phone:719-599-5083
Mailing Address - Fax:719-599-3291
Practice Address - Street 1:2438 RESEARCH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1094
Practice Address - Country:US
Practice Address - Phone:719-599-5083
Practice Address - Fax:719-599-3291
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT0003724152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOPT0003724OtherSTATE LICENSE