Healthcare Provider Details

I. General information

NPI: 1477892172
Provider Name (Legal Business Name): THE RETINA CENTER OF WESTERN COLORADO RLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2478 PATTERSON RD SUITE 7
GRAND JUNCTION CO
81505-3605
US

IV. Provider business mailing address

2478 PATTERSON RD SUITE 7
GRAND JUNCTION CO
81505-3605
US

V. Phone/Fax

Practice location:
  • Phone: 970-255-7065
  • Fax: 970-255-7076
Mailing address:
  • Phone: 970-255-7065
  • Fax: 970-255-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: MS. SUSAN WATERHOUSE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 970-255-7065