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General NPI Number Information
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NPI Number | 1215752472
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Entity Type | Organization
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Legal Business Name | EYE CARE ASSOICATES OF CO, LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 7960 S UNIVERSITY BLVD STE 102
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City | CENTENNIAL
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State | CO
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Zip | 80122-3167
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Country | US
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Telephone | 303-761-2345
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Fax | 303-761-3535
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Provider Business Mailing Address
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Address Line | PO BOX 879
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-0879
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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 | MEDICAL DIRECTOR
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Name | RUSSELL NATHANIEL OSNES
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Credential | OD
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Telephone | 651-452-0344
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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 |
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License Number State |
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