Healthcare Provider Details

I. General information

NPI: 1124674049
Provider Name (Legal Business Name): EYE CARE ASSOCIATES OF CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7539 S UNIVERSITY BLVD
CENTENNIAL CO
80122-3179
US

IV. Provider business mailing address

PO BOX 879
FORT WASHINGTON PA
19034-0879
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL NATHANIEL OSNES
Title or Position: DIRECTOR
Credential:
Phone: 651-452-0344