Organization
COLORADO RETINA ASSOCIATES, PLLC
Active
Parent organization
COLORADO RETINA ASSOCIATES, PLLC
Other names
Colorado Retina Associates, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLORADO RETINA ASSOCIATES, PLLC
Authorized official
KYLIE WAKASUGI (CREDENTIALING SPECIALIST)
(303) 261-1600
Entity
Organization
Contact information
Practice address
850 ENGLEWOOD PKWY STE 200, ENGLEWOOD, CO 80110-7399
(303) 261-1600
(303) 261-1601
Mailing address
PO BOX 17949, DENVER, CO 80217-0949
(303) 261-1600
(303) 261-1601
Taxonomy
Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
—
207WX0108X
Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74505807
—
CO
05
—
9000165843
—
CO
05
—
9000171077
—
CO
05
—
9000176494
—
CO
05
—
9000190491
—
CO
05
—
9000197544
—
CO
Enumeration date
02/28/2020
Last updated
06/14/2022
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