1568064541 NPI number — PEAK VIEW OPTOMETRY PETERSON, PLLC

Table of content: ERIK JOHN SMITH LCMHC (NPI 1417492695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568064541 NPI number — PEAK VIEW OPTOMETRY PETERSON, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK VIEW OPTOMETRY PETERSON, PLLC
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:
1568064541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6110 MARTINEZ ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT CARSON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80913-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-574-5252
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 E STEWART AVE BLDG 2017
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80914-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-574-5252
Provider Business Practice Location Address Fax Number:
719-631-7014
Provider Enumeration Date:
11/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
NOLASCO
Authorized Official First Name:
CHELSEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-574-5252

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)





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