# COLORADO RETINA ASSOCIATES, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COLORADO RETINA ASSOCIATES, PLLC
- **Other names:** Colorado Retina Associates, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1497389399
- **Legal business name:** COLORADO RETINA ASSOCIATES, PLLC
- **Authorized official:** KYLIE WAKASUGI (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (303) 261-1600

## Contact information

- **Practice address:** 850 ENGLEWOOD PKWY STE 200, ENGLEWOOD, CO 80110-7399
- **Practice address phone:** (303) 261-1600
- **Practice address fax:** (303) 261-1601
- **Mailing address:** PO BOX 17949, DENVER, CO 80217-0949
- **Mailing address phone:** (303) 261-1600
- **Mailing address fax:** (303) 261-1601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | NULL | — |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | — | — |
| 207WX0108X | Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician | — | NULL | — |
| 207WX0108X | Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/28/2020
- **Last updated:** 06/14/2022