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Individual

JONATHON JAMES CUCKLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OPTICIAN

Contact information

Practice address
1931 65TH AVE, SUITE C, GREELEY, CO 80634-7945
(970) 356-1047
Mailing address
912 BOLTZ CT, FORT COLLINS, CO 80525-2801
(970) 377-0592

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
143242
CO

Other

Enumeration date
11/01/2006
Last updated
07/09/2007
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