Provider Demographics
NPI:1023166204
Name:NURDEL, MANSUR (OD)
Entity type:Individual
Prefix:
First Name:MANSUR
Middle Name:
Last Name:NURDEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 E HIGHLANDS RANCH PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-8100
Mailing Address - Country:US
Mailing Address - Phone:303-683-4466
Mailing Address - Fax:303-683-4467
Practice Address - Street 1:3622 E HIGHLANDS RANCH PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-8100
Practice Address - Country:US
Practice Address - Phone:303-683-4466
Practice Address - Fax:303-683-4467
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34633839Medicaid
COC474678Medicare PIN
CO34633839Medicaid