Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1436 | CO |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1436 | CO |
NPI | 1164512257 |
---|---|
Provider Name | Dr. Richard Cross |
First Address | Boulder, CO 80301-3331 |
Second Address | Boulder, CO 80301-3331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 26/01/2009 |