Healthcare Provider Details

I. General information

NPI: 1205533445
Provider Name (Legal Business Name): HOLISTIC EYE CARE CENTER OF THE ROCKIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 KEN PRATT BLVD UNIT 120
LONGMONT CO
80501-9001
US

IV. Provider business mailing address

1225 KEN PRATT BLVD UNIT 120
LONGMONT CO
80501-9001
US

V. Phone/Fax

Practice location:
  • Phone: 720-513-1233
  • Fax: 720-302-0443
Mailing address:
  • Phone: 720-513-1233
  • Fax: 720-302-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM ROBERT UNDERWOOD JR.
Title or Position: OWNER
Credential: LAC
Phone: 720-513-1233