Healthcare Provider Details

I. General information

NPI: 1811076466
Provider Name (Legal Business Name): EYE SPECIALISTS OF COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 INTERNATIONAL CIR STE 102
COLORADO SPRINGS CO
80910-3152
US

IV. Provider business mailing address

PO BOX 280
COLORADO SPRINGS CO
80901-0280
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-8000
  • Fax: 719-434-8855
Mailing address:
  • Phone: 719-440-0058
  • Fax: 719-636-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number188
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES DEWEY MCMAHON
Title or Position: OWNEROPHTHALMOLOGIST
Credential: MD
Phone: 719-633-8000