Provider Demographics
NPI:1811978869
Name:JARRETT, JANICE I
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:I
Last Name:JARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 LEYDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2805
Mailing Address - Country:US
Mailing Address - Phone:303-333-9898
Mailing Address - Fax:303-333-0719
Practice Address - Street 1:1336 LEYDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2805
Practice Address - Country:US
Practice Address - Phone:303-333-9898
Practice Address - Fax:303-333-0719
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08013104Medicaid
U43346Medicare UPIN
COC43343Medicare PIN