Provider Demographics
NPI:1831389030
Name:CHESTER T ROE III MD L L C
Entity type:Organization
Organization Name:CHESTER T ROE III MD L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:303-758-5477
Mailing Address - Street 1:4999 E KENTUCKY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3901
Mailing Address - Country:US
Mailing Address - Phone:303-758-5477
Mailing Address - Fax:303-758-3069
Practice Address - Street 1:4999 E KENTUCKY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2281
Practice Address - Country:US
Practice Address - Phone:303-758-5477
Practice Address - Fax:303-758-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1145152W00000X
CO24061207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18689540Medicaid
COC372608Medicare PIN
COE60789Medicare UPIN
COCG9294Medicare PIN
COT60843Medicare UPIN