1295361798 NPI number — ROCKY MOUNTAIN EYE CENTER, INC., A COLORADO PROVIDER NETWORK

Table of content: (NPI 1295361798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295361798 NPI number — ROCKY MOUNTAIN EYE CENTER, INC., A COLORADO PROVIDER NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY MOUNTAIN EYE CENTER, INC., A COLORADO PROVIDER NETWORK
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:
Provider Other Organization Name Type Code:
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:
1295361798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 MONTEBELLO ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81001-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-545-1530
Provider Business Mailing Address Fax Number:
719-545-2899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2116 FREEDOM ROAD, #40
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINIDAD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81082-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-846-9236
Provider Business Practice Location Address Fax Number:
719-846-3768
Provider Enumeration Date:
03/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
COATNEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OPHTHALMOLOGIST
Authorized Official Telephone Number:
719-545-1530

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; 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