Healthcare Provider Details

I. General information

NPI: 1487477501
Provider Name (Legal Business Name): EYE CARE ASSOCIATES OF CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 S UNIVERSITY BLVD
CENTENNIAL CO
80122-3166
US

IV. Provider business mailing address

230 KINGS HWY E STE 333
HADDONFIELD NJ
08033-1907
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-2345
  • 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: MARQUETTA SHONTA LATIMORE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 319-204-5326