1831714237 NPI number — RETINA CONSULTANTS OF SOUTHERN COLORADO P C

Table of content: (NPI 1831714237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831714237 NPI number — RETINA CONSULTANTS OF SOUTHERN COLORADO P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETINA CONSULTANTS OF SOUTHERN COLORADO 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:
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:
1831714237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10035 PEARL PASS VIEW
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-473-9595
Provider Business Mailing Address Fax Number:
719-227-0669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10035 PEARL PASS VIEW
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-473-9595
Provider Business Practice Location Address Fax Number:
719-227-0669
Provider Enumeration Date:
06/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BEAL
Authorized Official First Name:
CHRISSY
Authorized Official Middle Name:
Authorized Official Title or Position:
FRONT OFFICE MANAGER
Authorized Official Telephone Number:
719-473-9595

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9000173749 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013250240 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 93008716 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 67174787 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97656372 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000181814 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com