Provider Demographics
NPI:1548254881
Name:REPINE VISION AND LASER PROFESSIONAL LLC
Entity type:Organization
Organization Name:REPINE VISION AND LASER PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REPINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-8848
Mailing Address - Street 1:8381 SOUTHPARK LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4508
Mailing Address - Country:US
Mailing Address - Phone:303-788-8848
Mailing Address - Fax:303-730-6163
Practice Address - Street 1:8381 SOUTHPARK LN
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4508
Practice Address - Country:US
Practice Address - Phone:303-788-8848
Practice Address - Fax:303-730-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
40376OtherBLUE CROSS BLUE SHIELD
CO55800068Medicaid
DC6461Medicare PIN
40376OtherBLUE CROSS BLUE SHIELD
COCD2603Medicare PIN