Healthcare Provider Details

I. General information

NPI: 1275660565
Provider Name (Legal Business Name): ARCHDALE OPTOMETRY CORPORATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7095 LEXINGTON DR
COLORADO SPRINGS CO
80918-6329
US

IV. Provider business mailing address

7095 LEXINGTON DR
COLORADO SPRINGS CO
80918-6329
US

V. Phone/Fax

Practice location:
  • Phone: 719-638-4010
  • Fax: 719-638-4021
Mailing address:
  • Phone: 719-638-4010
  • Fax: 719-638-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1466
License Number StateCO

VIII. Authorized Official

Name: THEODORE (TED) ARCHDALE
Title or Position: OWNER
Credential: OD
Phone: 719-638-4010