1144815325 NPI number — COLORADO WEST OPHTHALMOLOGY ASSOC. PC

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 1144815325 NPI number — COLORADO WEST OPHTHALMOLOGY ASSOC. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO WEST OPHTHALMOLOGY ASSOC. PC
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:
1144815325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 E PAVILION PL UNIT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-5499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-249-1210
Provider Business Mailing Address Fax Number:
970-249-3057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1426 MESA VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81416-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-874-8821
Provider Business Practice Location Address Fax Number:
970-874-3472
Provider Enumeration Date:
03/09/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WARE
Authorized Official First Name:
LETICIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
970-249-1210

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)

  • Identifier: 9000132032 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98604 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CJ7703 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".