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General NPI Number Information
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NPI Number | 1154457687
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Entity Type | Organization
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Legal Business Name | ARCHDALE EYECARE PC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 1541 S 8TH ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-1923
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Country | US
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Telephone | 719-577-4400
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Fax | 719-577-4954
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Provider Business Mailing Address
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Address Line | 1541 S 8TH ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-1923
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Country | US
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Telephone | 719-577-4400
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Fax | 719-577-4954
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Authorized Official
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Title or Position | OWNER
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Name | THEODORE (TED) ARCHDALE
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Credential | OD
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Telephone | 719-577-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1466
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License Number State | CO
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