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General NPI Number Information
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NPI Number | 1063804102
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Entity Type | Organization
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Legal Business Name | INNOVATIVE EYE CARE LLC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 21 KINGS CROSSING RD STE 201
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City | WINTER PARK
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State | CO
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Zip | 80482
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Country | US
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Telephone | 970-749-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 WYNKOOP ST APT 404
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City | DENVER
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State | CO
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Zip | 80202-1076
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOHN PARKINSON
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Credential |
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Telephone | 970-749-4471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 30773
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License Number State | CO
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