Healthcare Provider Details

I. General information

NPI: 1205699279
Provider Name (Legal Business Name): EYE CARE ASSOCIATES OF CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5075 E UNIVERSITY AVE
PLEASANT HILL IA
50327-7001
US

IV. Provider business mailing address

PO BOX 879
FORT WASHINGTON PA
19034-0879
US

V. Phone/Fax

Practice location:
  • Phone: 515-265-5322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DAVID DEPPEN
Title or Position: SENIOR DIRECTOR, REVENUE CYCLE MANA
Credential:
Phone: 937-539-8057