Provider Demographics
NPI:1740355734
Name:TORGERSON, MICHAEL S (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:TORGERSON
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 1:1820 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1423
Mailing Address - Country:US
Mailing Address - Phone:970-493-6360
Mailing Address - Fax:
Practice Address - Street 1:1820 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1423
Practice Address - Country:US
Practice Address - Phone:970-493-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1415152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1622990OtherCLARITY VISION
CO060075OtherNVA
CO11575OtherOPTICARE
COEYEMEDOtherCO1415
CO4393OtherAVESIS
CO01431072Medicaid
CO5235440001OtherDURABLE MEDICAL EQUIPMENT
CO08014151Medicaid
CO920353OtherEYE SPECIALISTS
COSPECTERAOther24512
CO11575OtherOPTICARE
CO550858Medicare PIN
CO551618Medicare PIN