Provider Demographics
NPI:1376690537
Name:JARVIS, KERRY (OD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:WAYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:550 S WADSWORTH BLVD UNIT 415
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3118
Mailing Address - Country:US
Mailing Address - Phone:303-989-2020
Mailing Address - Fax:
Practice Address - Street 1:550 S WADSWORTH BLVD UNIT 415
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3118
Practice Address - Country:US
Practice Address - Phone:303-989-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU98934Medicare UPIN