Healthcare Provider Details

I. General information

NPI: 1336758184
Provider Name (Legal Business Name): CHILDREN'S EYE PHYSICIANS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 PEARL ST STE 1C
BOULDER CO
80302-3851
US

IV. Provider business mailing address

4875 WARD RD STE 600
WHEAT RIDGE CO
80033-1944
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-9456
  • Fax: 303-467-0145
Mailing address:
  • Phone: 303-456-9456
  • Fax: 303-463-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LYNETTE M BRIDGES
Title or Position: CEO
Credential:
Phone: 303-456-9456