Healthcare Provider Details

I. General information

NPI: 1679582480
Provider Name (Legal Business Name): ASSOCIATED EYE CARE PROFESSIONALS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 LIONESS WAY SUITE 190
PARKER CO
80134-5640
US

IV. Provider business mailing address

11960 LIONESS WAY SUITE 190
PARKER CO
80134-5640
US

V. Phone/Fax

Practice location:
  • Phone: 303-794-1111
  • Fax: 303-347-1341
Mailing address:
  • Phone: 303-794-1111
  • Fax: 303-347-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2148
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number15013
License Number StateCO

VIII. Authorized Official

Name: E RANDY CRAVEN
Title or Position: OWNER
Credential: MD
Phone: 303-794-1111