Healthcare Provider Details

I. General information

NPI: 1427512375
Provider Name (Legal Business Name): SOUTHERN COLORADO OCULOFACIAL PLASTIC SURGERY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10035 PEARL PASS VW STE 120
COLORADO SPRINGS CO
80924-8223
US

IV. Provider business mailing address

10035 PEARL PASS VW STE 120
COLORADO SPRINGS CO
80924-8223
US

V. Phone/Fax

Practice location:
  • Phone: 719-418-5711
  • Fax: 719-418-5778
Mailing address:
  • Phone: 719-418-5711
  • Fax: 719-418-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery 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. SCOTT JONES
Title or Position: OWNER
Credential: MD
Phone: 719-418-5711