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General NPI Number Information
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NPI Number | 1821268095
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Entity Type | Organization
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Legal Business Name | FRONT RANGE EYECARE LLC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 5474 TOMAH DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1928
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Country | US
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Telephone | 719-598-2900
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Fax | 719-264-0766
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Provider Business Mailing Address
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Address Line | 5474 TOMAH DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1928
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Country | US
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Telephone | 719-598-2900
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Fax | 719-264-0766
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY J SIKORSKI
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Credential | OD
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Telephone | 719-598-2900
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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 | 2089
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License Number State | CO
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