1295435881 NPI number — CHILDREN'S OPTICAL OF NORTHERN COLORADO LLC

Table of content: (NPI 1295435881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295435881 NPI number — CHILDREN'S OPTICAL OF NORTHERN COLORADO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S OPTICAL OF NORTHERN COLORADO 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:
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:
1295435881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 E HARMONY RD UNIT 350A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80528-3404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-214-8175
Provider Business Mailing Address Fax Number:
970-788-7376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 E HARMONY RD UNIT 350A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80528-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-214-8175
Provider Business Practice Location Address Fax Number:
970-788-7376
Provider Enumeration Date:
03/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
970-214-8175

Provider Taxonomy Codes

  • Taxonomy code: 207WX0110X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053572438 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255091716 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com