Organization
SPIVACK VISION CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BECKY RUDOLPH (CEO)
(303) 740-2414
Entity
Organization
Contact information
Practice address
6881 S YOSEMITE ST, CENTENNIAL, CO 80112-1406
(303) 740-9310
(303) 740-5494
Mailing address
6881 S YOSEMITE ST, CENTENNIAL, CO 80112-1406
(303) 740-9310
(303) 740-5494
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SPA2908
ANTHEM BC/BS
CO
Enumeration date
04/18/2006
Last updated
09/10/2007
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