Provider Demographics
NPI:1902941644
Name:TAYLOR, WARREN L
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 W BOWLES AVE STE G
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-8615
Mailing Address - Country:US
Mailing Address - Phone:303-798-2020
Mailing Address - Fax:303-979-9420
Practice Address - Street 1:9046 W BOWLES AVE STE G
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-8615
Practice Address - Country:US
Practice Address - Phone:303-798-2020
Practice Address - Fax:303-979-9420
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO410011300Medicare PIN
COT60853Medicare UPIN
COC40933Medicare PIN
CO0184880001Medicare NSC