Provider Demographics
NPI:1457518508
Name:STOFFREGEN, NICHOLAS P (OD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:STOFFREGEN
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 1:12942 GRANT CIR E
Mailing Address - Street 2:UNIT A
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2497
Mailing Address - Country:US
Mailing Address - Phone:816-721-3684
Mailing Address - Fax:
Practice Address - Street 1:9499 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6532
Practice Address - Country:US
Practice Address - Phone:303-427-0872
Practice Address - Fax:303-412-0619
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2694152W00000X
MO2004018248152W00000X
IL2962455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist