MEDICARE: PEAK VIEW OPTOMETRY FORT CARSON, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1194327148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK VIEW OPTOMETRY FORT CARSON, LLC

Provider Business Mailing Address
First Line	:	6110 MARTINEZ ST
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-2048
Country	:	US
Telephone Number	:	719-368-2446
Fax Number	:	719-631-7014

Provider Business Practice Location Address
First Line	:	6110 MARTINEZ ST
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-2048
Country	:	US
Telephone Number	:	719-368-2446
Fax Number	:	719-631-7014

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHELSEY NOLASCO
Credential	:	OD
Telephone Number	:	719-368-2446

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	11/13/2020

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