Healthcare Provider Details

I. General information

NPI: 1942072194
Provider Name (Legal Business Name): SOCO OPHTHALMOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 MARK DABLING BLVD STE 190
COLORADO SPRINGS CO
80919-2270
US

IV. Provider business mailing address

5755 MARK DABLING BLVD STE 190
COLORADO SPRINGS CO
80919-2270
US

V. Phone/Fax

Practice location:
  • Phone: 719-257-3959
  • Fax: 719-934-9657
Mailing address:
  • Phone: 719-257-3959
  • Fax: 719-257-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD STEVENSON
Title or Position: PHYSICIAN
Credential:
Phone: 719-257-3959