Madison Street Provider Network INC

NPI #1831796010 in Thornton, Colorado

Provider Information

NPI Number: 1831796010
Entity Type: Organization
Organization Name: Madison Street Provider Network INC
Subpart: Yes (part of a larger organization)
Parent Organization: MADISON STREET PROVIDER NETWORK INC.
Primary Specialty: Ophthalmology
Enumeration Date: Oct 1, 2020
Last Updated: Oct 1, 2020

Practice Location

Address: 10001 N. WASHINGTON ST.
City: Thornton
State: Colorado
ZIP Code: 80229-2050
Phone: (303) 451-8075

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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