1508994641 NPI number — WESTERN ROCKIES EYE CENTER,P.C.

Table of content: (NPI 1508994641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508994641 NPI number — WESTERN ROCKIES EYE CENTER,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN ROCKIES EYE CENTER,P.C.
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:
1508994641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2460 PATTERSON RD UNIT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81505-1027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
197-245-1514
Provider Business Mailing Address Fax Number:
970-245-4936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2460 PATTERSON RD UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81505-1027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
190-245-1514
Provider Business Practice Location Address Fax Number:
970-245-4936
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
BOOKKEEPER
Authorized Official Telephone Number:
970-243-9000

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X , with the licence number: 3578 , 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: 55432310 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com