Provider Demographics
NPI:1366492480
Name:RASTRELLI, PAUL D (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:RASTRELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8703
Mailing Address - Country:US
Mailing Address - Phone:719-630-3937
Mailing Address - Fax:719-635-3578
Practice Address - Street 1:3155 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8703
Practice Address - Country:US
Practice Address - Phone:719-630-3937
Practice Address - Fax:719-635-3578
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36999207W00000X
NM2003-0594207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01369990Medicaid
CO0452890001OtherMEDICARE DMERC
CT920717020820OtherEYE SPECIALISTS
COCO6999OtherEYE MED EYECARE
CONM009J51OtherBCBS NM
NM343327601Medicaid
COK2189OtherFEDERAL BCBS
CO343327601OtherNM MEDICARE
CO180043214OtherRAILROAD MEDICARE
COK2189OtherANTHEM
CORAK2189OtherBCBS NORTH DAKOTA
CO0452890001OtherMEDICARE DMERC
CO449808Medicare ID - Type Unspecified