MEDICARE: NATURAL EYES LASER AND SURGERY CENTER, LLLP

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	261QA1903X	Ambulatory Surgical Clinic/Center	0304	CO
2	261Q00000X	Clinic/Center	160559	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922090844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURAL EYES LASER AND SURGERY CENTER, LLLP

Provider Business Mailing Address
First Line	:	2485 E. PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909
Country	:	US
Telephone Number	:	719-634-2001
Fax Number	:	719-634-2211

Provider Business Practice Location Address
First Line	:	2485 E. PIKES PEAK AVE
Second Line	:
City	:	COLO. SPRINGS
State	:	CO
Zip	:	80909
Country	:	US
Telephone Number	:	719-634-2001
Fax Number	:	719-634-2211

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN R. WRIGHT
Credential	:	D.O.
Telephone Number	:	719-634-2001

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	11/02/2009

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