Healthcare Provider Details

I. General information

NPI: 1083039747
Provider Name (Legal Business Name): EUNOIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 D AVENUE
LIMON CO
80828
US

IV. Provider business mailing address

355 D AVENUE
LIMON CO
80828
US

V. Phone/Fax

Practice location:
  • Phone: 660-973-3195
  • Fax:
Mailing address:
  • Phone: 660-973-3195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DIANA DEE BRISCOE
Title or Position: LENS TECHNICIAN
Credential:
Phone: 660-973-3195