1326378209 NPI number — EYE ON LIVING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326378209 NPI number — EYE ON LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE ON LIVING, INC.
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:
1326378209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3251
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80307-3251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-543-0669
Provider Business Mailing Address Fax Number:
303-494-0530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 S 40TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80305-5905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-543-0669
Provider Business Practice Location Address Fax Number:
303-494-0530
Provider Enumeration Date:
12/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZEKERT
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
CEO, CLINICAL MANAGER
Authorized Official Telephone Number:
303-543-0669

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XL0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6310855 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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