Provider Demographics
NPI:1629078019
Name:REDMOND, JENNIFER SLEBOS (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SLEBOS
Last Name:REDMOND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24200 E SMOKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1381
Mailing Address - Country:US
Mailing Address - Phone:720-870-2828
Mailing Address - Fax:720-870-2117
Practice Address - Street 1:24200 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1381
Practice Address - Country:US
Practice Address - Phone:720-870-2828
Practice Address - Fax:720-870-2117
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC450498OtherPTAN
CO0293200001Medicare NSC
COC450498OtherPTAN