Madison Street Provider Network, LLC

NPI #1154929602 in Englewood, Colorado

Provider Information

NPI Number: 1154929602
Entity Type: Organization
Organization Name: Madison Street Provider Network, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: MADISON STREET PROVIDER NETWORK, LLC
Primary Specialty: Ophthalmology
Enumeration Date: Oct 15, 2020
Last Updated: Oct 15, 2020

Practice Location

Address: 125 INVERNESS DR E STE 200
City: Englewood
State: Colorado
ZIP Code: 80112-5138
Phone: (303) 733-2020

Authorized Official

Name: GEORGE L NEAL
Title: PRESIDENT
Phone: (469) 214-0144

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X
Ophthalmology	207W00000X	Primary

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