Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 E. PIKES PEAK AVE
COLO. SPRINGS CO
80909
US

IV. Provider business mailing address

2485 E. PIKES PEAK AVE
COLORADO SPRINGS CO
80909
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-2001
  • Fax: 719-634-2211
Mailing address:
  • Phone: 719-634-2001
  • Fax: 719-634-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0304
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number160559
License Number StateCO

VIII. Authorized Official

Name: DR. JOHN R. WRIGHT
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 719-634-2001