Healthcare Provider Details

I. General information

NPI: 1467578278
Provider Name (Legal Business Name): FAMILY EYE CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 S YOSEMITE ST
CENTENNIAL CO
80112-1406
US

IV. Provider business mailing address

6881 S YOSEMITE ST
CENTENNIAL CO
80112-1406
US

V. Phone/Fax

Practice location:
  • Phone: 303-393-8378
  • Fax: 720-872-4902
Mailing address:
  • Phone: 303-393-8378
  • Fax: 720-872-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAWN M. DEMOSS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 303-393-8378