MEDICARE: EYE CARE ASSOCIATES OF CO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1619845625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE ASSOCIATES OF CO, LLC

Provider Business Mailing Address
First Line	:	230 KINGS HWY E # 333
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-1907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 S FEDERAL BLVD UNIT D&E
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-2965
Country	:	US
Telephone Number	:	720-812-9904
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MARQUETTA SHONTA LATIMORE
Credential	:
Telephone Number	:	515-771-3757

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	10/29/2025

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