Healthcare Provider Details

I. General information

NPI: 1750411062
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: 03/06/2007
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HOSPITAL DR
RATON NM
87740-2032
US

IV. Provider business mailing address

27 MONTEBELLO RD
PUEBLO CO
81001-1236
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-2789
  • Fax: 575-445-2780
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 State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

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