1184645178 NPI number — SOUTHLANDS VISION ASSOCIATES

Table of content: (NPI 1184645178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184645178 NPI number — SOUTHLANDS VISION ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHLANDS VISION ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALTITUDE EYE CARE AT SOUTHLANDS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184645178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6290 S MAIN ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80016-5379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-766-0545
Provider Business Mailing Address Fax Number:
303-766-0624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6290 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80016-5322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-480-4711
Provider Business Practice Location Address Fax Number:
720-870-9438
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLSON
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
303-755-0545

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com