Provider Demographics
NPI:1174589170
Name:SCHOLTEN-LELLBACH, RUTH ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ELLEN
Last Name:SCHOLTEN-LELLBACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15101 E ILIFF AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4543
Mailing Address - Country:US
Mailing Address - Phone:303-366-1235
Mailing Address - Fax:303-366-2886
Practice Address - Street 1:15101 E ILIFF AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4543
Practice Address - Country:US
Practice Address - Phone:303-366-1235
Practice Address - Fax:303-366-2886
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU63181Medicare UPIN
COCO41119Medicare PIN
COCO41119Medicare PIN