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General NPI Number Information
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NPI Number | 1285608075
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Entity Type | Organization
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Legal Business Name | PUEBLO CO OPHTHALMOLOGY ASC LLC
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 1402 FORTINO BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-2033
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Country | US
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Telephone | 719-583-8700
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Fax | 719-583-9700
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Provider Business Mailing Address
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Address Line | 1A BURTON HILLS BLVD STE 300
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City | NASHVILLE
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State | TN
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Zip | 37215-6153
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Country | US
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Telephone | 615-263-4011
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Fax | 615-234-1720
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY SNODGRASS
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Credential |
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Telephone | 615-665-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 208
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License Number State | CO
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