1811495070 NPI number — COLORADO EYE CENTER, LLC

Table of content: (NPI 1811495070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811495070 NPI number — COLORADO EYE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO EYE CENTER, LLC
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:
6
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:
1811495070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 GARDEN CTR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80020-7090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-469-1941
Provider Business Mailing Address Fax Number:
303-469-6634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9835 S PARKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80134-8815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-841-3937
Provider Business Practice Location Address Fax Number:
303-805-4370
Provider Enumeration Date:
01/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEAL
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
844-377-6468

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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