| NPI | 1508435967 |
|---|---|
| Former Legal Business Name | COLORADO RETINA ASSOCIATES, PC |
| Entity Type | Organization |
| Authorized Contact | KYLIE WAKASUGI Credentialing Specialist 303-261-1600 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2021-11-16 |