Healthcare Provider Details

I. General information

NPI: 1275725889
Provider Name (Legal Business Name): TILLMAN EYE CARE GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8370 NORTHFIELD BLVD SUITE 1795
DENVER CO
80238-3132
US

IV. Provider business mailing address

8370 NORTHFIELD BLVD SUITE 1795
DENVER CO
80238-3132
US

V. Phone/Fax

Practice location:
  • Phone: 303-373-1700
  • Fax:
Mailing address:
  • Phone: 303-373-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2012
License Number StateCO

VIII. Authorized Official

Name: DR. STEVEN C TILLMAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 303-373-1700