Provider Demographics
NPI:1861520942
Name:BLAUROCK, JENNIFER (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BLAUROCK
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 1:577 W WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1668
Mailing Address - Country:US
Mailing Address - Phone:760-285-4165
Mailing Address - Fax:
Practice Address - Street 1:8370 NORTHFIELD BLVD
Practice Address - Street 2:STE 1795
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3132
Practice Address - Country:US
Practice Address - Phone:303-373-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11042 TPA152W00000X
CO2975152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist