Provider Demographics
NPI:1932341039
Name:OPTIC DIMENSION, PLLC
Entity Type:Organization
Organization Name:OPTIC DIMENSION, PLLC
Other - Org Name:OPTIC DIMENSION, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-278-4191
Mailing Address - Street 1:14500 W. COLFAX AVE
Mailing Address - Street 2:SUITE #309
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3229
Mailing Address - Country:US
Mailing Address - Phone:303-278-4191
Mailing Address - Fax:303-271-0433
Practice Address - Street 1:14500 W. COLFAX AVE
Practice Address - Street 2:SUITE #309
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3229
Practice Address - Country:US
Practice Address - Phone:303-278-4191
Practice Address - Fax:303-271-0433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIC DIMENSION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-03
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty