1457335077 NPI number — DENVER EYE SURGERY CENTER, LLC

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 1457335077 NPI number — DENVER EYE SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENVER EYE SURGERY 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:
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:
1457335077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13772 DENVER WEST PKWY STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-279-6600
Provider Business Mailing Address Fax Number:
303-279-9140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13772 DENVER WEST PKWY
Provider Second Line Business Practice Location Address:
BLDG#55, STE#120
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-279-6600
Provider Business Practice Location Address Fax Number:
303-279-9140
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BECKER
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
303-273-8774

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04510087 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 427718 . This is a "LEGACY TM" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 490000347 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CK2878 . This is a "LEGACY JS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 803688 . This is a "LEGACY NM" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 803092 . This is a "LEGACY RK" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CK2868 . This is a "LEGACY VC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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