MEDICARE: ROCKY MOUNTAIN EYE CARE INC

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	152WC0802X	Corneal and Contact Management Optometrist
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487058491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN EYE CARE INC

Provider Business Mailing Address
First Line	:	9362 GRAND CORDERA PKWY STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7007
Country	:	US
Telephone Number	:	719-888-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	9362 GRAND CORDERA PKWY STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7007
Country	:	US
Telephone Number	:	719-888-4688
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TED R LYMER
Credential	:	OD
Telephone Number	:	719-888-4688

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	08/18/2020

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