Provider Demographics
NPI:1902807332
Name:MARLATT, JEFFREY CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CRAIG
Last Name:MARLATT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 STATION ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6808
Mailing Address - Country:US
Mailing Address - Phone:303-925-0075
Mailing Address - Fax:303-925-0079
Practice Address - Street 1:9400 STATION ST
Practice Address - Street 2:SUITE 150
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6808
Practice Address - Country:US
Practice Address - Phone:303-925-0075
Practice Address - Fax:303-925-0079
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2038152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800621Medicare PIN
COU78680Medicare UPIN