Provider Demographics
NPI:1841263571
Name:FUKAI, MICHAEL (OD11)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FUKAI
Suffix:
Gender:M
Credentials:OD11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 HECLA DR
Mailing Address - Street 2:STE C
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2318
Mailing Address - Country:US
Mailing Address - Phone:303-666-7226
Mailing Address - Fax:303-665-3367
Practice Address - Street 1:1371 HECLA DR
Practice Address - Street 2:STE C
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2318
Practice Address - Country:US
Practice Address - Phone:303-666-7226
Practice Address - Fax:303-665-3367
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T93316Medicare UPIN
F1613Medicare ID - Type Unspecified