Provider Demographics
NPI:1649508797
Name:OPTIQUE OF DENVER, LLC
Entity type:Organization
Organization Name:OPTIQUE OF DENVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER OPTICIAN/OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRUHSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:ABOM, FNAO
Authorized Official - Phone:303-844-3937
Mailing Address - Street 1:1580 BLAKE STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1322
Mailing Address - Country:US
Mailing Address - Phone:303-844-3937
Mailing Address - Fax:303-844-3940
Practice Address - Street 1:1580 BLAKE STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1322
Practice Address - Country:US
Practice Address - Phone:303-844-3937
Practice Address - Fax:303-844-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001592156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty