Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2731 | CO |
NPI | 1013146158 |
---|---|
Provider Name | Dr. Nancy Van |
First Address | Lakewood, CO 80227-2752 |
Second Address | Denver, CO 80212-7410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 09/02/2014 |