Healthcare Provider Details

I. General information

NPI: 1861533457
Provider Name (Legal Business Name): ROCKY MOUNTAIN EYE CENTER, INC. A COLORADO PROVIDER NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 FREEDOM RD
TRINIDAD CO
81082-1210
US

IV. Provider business mailing address

27 MONTEBELLO RD
PUEBLO CO
81001-1236
US

V. Phone/Fax

Practice location:
  • Phone: 719-846-9236
  • Fax: 719-846-3768
Mailing address:
  • Phone: 719-545-1530
  • Fax: 719-545-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANN M HULETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 719-545-1530