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General NPI Number Information
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NPI Number | 1508383126
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Entity Type | Organization
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Legal Business Name | ABBA DRY EYE & ALLERGY CLINIC, P.C.
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 08/24/2017
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Provider Practice Location Address
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Address Line | 4465 NORTHPARK DR STE 206
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-4238
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Country | US
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Telephone | 719-424-4496
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Fax | 719-301-1518
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Provider Business Mailing Address
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Address Line | 1130 LAKE PLAZA DR STE 145
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3595
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Country | US
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Telephone | 719-630-8200
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Fax | 719-630-8201
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Authorized Official
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Title or Position | PROVIDER COORDINATOR
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Name | MARY WINTER
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Credential |
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Telephone | 719-424-4497
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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 | 1000
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License Number State | CO
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