Healthcare Provider Details

I. General information

NPI: 1093207177
Provider Name (Legal Business Name): ACUITY EYECARE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 S COLORADO BLVD UNIT O
DENVER CO
80222-4011
US

IV. Provider business mailing address

4835 LBJ
DALLAS TX
75244-6005
US

V. Phone/Fax

Practice location:
  • Phone: 303-757-6747
  • Fax:
Mailing address:
  • Phone: 214-396-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA K. ALLISON
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 618-462-9818