Provider Demographics
NPI:1770564494
Name:ALDERETE, RAUL (OD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:ALDERETE
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 1:1641 CALIFORNIA ST STE 101B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3720
Mailing Address - Country:US
Mailing Address - Phone:303-825-2500
Mailing Address - Fax:303-825-3034
Practice Address - Street 1:1641 CALIFORNIA ST STE 101B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-3720
Practice Address - Country:US
Practice Address - Phone:303-825-2500
Practice Address - Fax:303-825-3034
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT-92885Medicare UPIN
CO340405Medicare PIN