Healthcare Provider Details

I. General information

NPI: 1306123096
Provider Name (Legal Business Name): AMEDCO COLORADO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N WEBER ST #360
COLORADO SPRINGS CO
80907-7532
US

IV. Provider business mailing address

8076 W SAHARA AVE
LAS VEGAS NV
89117-7930
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-4000
  • Fax: 719-632-6088
Mailing address:
  • Phone: 877-881-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA PERREIRA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 877-881-0022