Healthcare Provider Details

I. General information

NPI: 1548215346
Provider Name (Legal Business Name): SUMMIT EYE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 E 15TH ST
LOVELAND CO
80538-8701
US

IV. Provider business mailing address

3650 E 15TH ST
LOVELAND CO
80538-8701
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-1107
  • Fax: 970-669-8849
Mailing address:
  • Phone: 970-669-1107
  • Fax: 970-669-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number99143599
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number28606
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number28606
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number99143599
License Number StateCO

VIII. Authorized Official

Name: DR. JOHN D KIRK
Title or Position: PRESIDENT
Credential: M.D. FACS
Phone: 970-669-1107