Healthcare Provider Details

I. General information

NPI: 1023763968
Provider Name (Legal Business Name): EYE CENTER OPTICAL OF NORTHERN COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 WARD RD
WHEAT RIDGE CO
80033-1951
US

IV. Provider business mailing address

1725 E PROSPECT RD
FORT COLLINS CO
80525-1307
US

V. Phone/Fax

Practice location:
  • Phone: 303-467-0502
  • Fax: 303-467-0500
Mailing address:
  • Phone: 970-221-2222
  • Fax: 970-837-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERYL BARBER
Title or Position: PROVIDER SERVICES MANAGER
Credential:
Phone: 970-221-2222