Individual
DR. DALE G LERVICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
7586 W JEWELL AVE, SUITE 104, LAKEWOOD, CO 80232-6890
(303) 233-7575
(303) 233-4740
Mailing address
7586 W JEWELL AVE, SUITE 104, LAKEWOOD, CO 80232-6890
(303) 233-7575
(303) 233-4740
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
777
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08007775
—
CO
01
—
32959
BLUE CROSS
CO
Enumeration date
07/15/2005
Last updated
04/25/2012
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