# COLORADO RETINA ASSOCIATES, PLLC

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

## Provider details

- **NPI number:** 1508435967
- **Legal business name:** COLORADO RETINA ASSOCIATES, PLLC
- **Authorized official:** KYLIE WAKASUGI (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (303) 261-1600

## Contact information

- **Practice address:** 3401 QUEBEC ST \# 105, DENVER, CO 80207-2322
- **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) 261-1600

## Taxonomy

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

## Other

- **Enumeration date:** 06/21/2021
- **Last updated:** 11/16/2021