MEDICARE: EYE CARE ASSOCIATES OF CO, 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	:	1598574113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE ASSOCIATES OF CO, LLC

Provider Business Mailing Address
First Line	:	230 KINGS HWY E STE 333
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-1907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4557 MILLBRANCH RD STE 16
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38116-7437
Country	:	US
Telephone Number	:	901-346-8222
Fax Number	:

Authorized Official
Title or Position	:	DIR RCM
Name	:	DAVID DEPPEN
Credential	:
Telephone Number	:	937-539-8057

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	01/07/2025

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