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General NPI Number Information
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NPI Number | 1952002248
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Entity Type | Organization
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Legal Business Name | EYE CENTER OF NORTHERN COLORADO, P.C
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 101 ERIE PKWY STE 202
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City | ERIE
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State | CO
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Zip | 80516-4072
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Country | US
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Telephone | 720-933-6615
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 E PROSPECT RD
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City | FORT COLLINS
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State | CO
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Zip | 80525-1307
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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 | DIRECTOR OF REVENUE
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Name | THOMAS R ZDRALE
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Credential |
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Telephone | 724-713-1025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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