Provider Demographics
NPI:1770702581
Name:COLORADO LASER SURGEONS
Entity type:Organization
Organization Name:COLORADO LASER SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KETTY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STREIFEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-393-8565
Mailing Address - Street 1:55 MADISON ST
Mailing Address - Street 2:#300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5419
Mailing Address - Country:US
Mailing Address - Phone:303-393-8565
Mailing Address - Fax:
Practice Address - Street 1:55 MADISON ST
Practice Address - Street 2:#300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5419
Practice Address - Country:US
Practice Address - Phone:303-393-8565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty