1679525208 NPI number — BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION

Table of content: (NPI 1679525208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679525208 NPI number — BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION
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:
1679525208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 FORTINO BLVD
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:
81008-1856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-542-3555
Provider Business Mailing Address Fax Number:
719-542-0425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 DOZIER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANON CITY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81212-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-276-0344
Provider Business Practice Location Address Fax Number:
719-269-7446
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COZZETTA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-276-0344

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1347 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1700048329 . This is a "DR ASHBY NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44730578 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83707255 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88124088 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629078050 . This is a "DR BACK NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53276060 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043277973 . This is a "DR COZZETTA NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12538248 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760476634 . This is a "DR LIPPA NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71976311 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629303631 . This is a "DR FELDMAN NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1972555001 . This is a "DR SALDIVIA NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1164415345 . This is a "DR WALDMAN NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1386874048 . This is a "DR LEWIS NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39279073 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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