Provider Demographics
NPI:1801286414
Name:DAVID M T LEVERETT, OD, PC
Entity type:Organization
Organization Name:DAVID M T LEVERETT, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-521-6773
Mailing Address - Street 1:2205 PINTAIL DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-7360
Mailing Address - Country:US
Mailing Address - Phone:303-521-6773
Mailing Address - Fax:
Practice Address - Street 1:5700 W 88TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3030
Practice Address - Country:US
Practice Address - Phone:303-650-6006
Practice Address - Fax:303-650-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0001892152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU98893Medicare UPIN