Healthcare Provider Details

I. General information

NPI: 1306644463
Provider Name (Legal Business Name): SOCO OPHTHALMOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W ABRIENDO AVE
PUEBLO CO
81004-1559
US

IV. Provider business mailing address

5755 MARK DABLING BLVD STE 190
COLORADO SPRINGS CO
80919-2270
US

V. Phone/Fax

Practice location:
  • Phone: 719-257-3959
  • Fax: 719-257-3959
Mailing address:
  • Phone: 719-257-3959
  • Fax: 719-257-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD STEVENSON
Title or Position: DO
Credential:
Phone: 719-257-3959