1679525208 NPI number — BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION

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 1679525208 NPI number — BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION
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:
1679525208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 FORTINO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81008-1856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-542-3555
Provider Business Mailing Address Fax Number:
719-542-0425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 DOZIER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANON CITY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81212-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-276-0344
Provider Business Practice Location Address Fax Number:
719-269-7446
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COZZETTA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-276-0344

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1347 , 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: 1700048329 . This is a "DR ASHBY NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44730578 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83707255 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88124088 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629078050 . This is a "DR BACK NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53276060 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043277973 . This is a "DR COZZETTA NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12538248 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760476634 . This is a "DR LIPPA NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71976311 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629303631 . This is a "DR FELDMAN NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1972555001 . This is a "DR SALDIVIA NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1164415345 . This is a "DR WALDMAN NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1386874048 . This is a "DR LEWIS NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39279073 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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