Healthcare Provider Details

I. General information

NPI: 1730366808
Provider Name (Legal Business Name): MITCHELL J MAYO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 HOLLOW BROOK DR STE 40
COLORADO SPRINGS CO
80918-1451
US

IV. Provider business mailing address

2155 HOLLOW BROOK DR STE 40
COLORADO SPRINGS CO
80918-1451
US

V. Phone/Fax

Practice location:
  • Phone: 719-272-6416
  • Fax: 719-272-6408
Mailing address:
  • Phone: 719-272-6416
  • Fax: 719-272-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL MAYO
Title or Position: OWNER
Credential: BCO
Phone: 719-272-6416