Individual provider Active NPI

Tyler Leuenberger

  • Optometrist
  • Denver, CO
National Provider Identifier
1417519661
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT0003508 Issued in CO
Practice address
4380 S Syracuse St
Denver, CO 80237-2607
Phone
(303) 991-9628
NPI assigned
Jul 8, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT0003508 CO Primary

Addresses

Primary practice location

4380 S Syracuse St
Denver, CO 80237-2607

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190815001982 CO Practitioner - Optometry 6103153002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Colorado PCGroup PAC ID 7113359415, 58 clinicians

Practice addresses (Care Compare)

1550 S Potomac St
Suite 155
Aurora, CO 80012-5444
Phone (303) 369-1020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT0003508COMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Colorado PC Optometrist CurrentSince Oct 11, 2019 Accepting new patients
Myeyedr Optometry of Colorado PC Optometrist Current Accepting new patients
Myeyedr Optometry of Colorado PC Optometrist CurrentSince Oct 11, 2019 Accepting new patients
US Anesthesia Partners of Colorado Inc. PastSince Jul 1, 2012 Accepting new patients

Locations

18801 E Hampden Ave
Ste 176
Aurora, CO 80013
Phone (303) 690-6510

1550 S Potomac St
Ste 155
Aurora, CO 80012
Phone (303) 369-1020

6881 S Yosemite St
Centennial, CO 80112
Phone (303) 393-8378

1050 17th St
Ste A110
Denver, CO 80265
Phone (303) 298-9410

2795 S Colorado Blvd
Denver, CO 80222
Phone (303) 782-0470

15530 E Broncos Pkwy
Unit 200
Englewood, CO 80112
Phone (303) 766-2020

5116 S Broadway
Englewood, CO 80113
Phone (303) 761-3285

200 W County Line Rd
Ste 150
Highlands Ranch, CO 80129
Phone (303) 794-2433

2766 S Wadsworth Blvd
Lakewood, CO 80227
Phone (303) 935-2020

10521 S Parker Rd
Parker, CO 80134
Phone (303) 841-8243

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1417519661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4380 S SYRACUSE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802372607",
            "telephone_number": "303-991-9628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEUENBERGER",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-08",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT0003508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.