Provider Demographics
NPI:1861261893
Name:LOMAS, JAKE L (RPSGT, RST)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:L
Last Name:LOMAS
Suffix:
Gender:M
Credentials:RPSGT, RST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-3005
Mailing Address - Country:US
Mailing Address - Phone:325-374-4021
Mailing Address - Fax:
Practice Address - Street 1:15 W DRY CREEK CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4485
Practice Address - Country:US
Practice Address - Phone:303-952-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
26619156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist