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	:	1811750706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE ASSOCIATES OF CO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 879
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-0879
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 S GILBERT ST STE 2
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4565
Country	:	US
Telephone Number	:	319-359-3307
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, REVENUE CYCLE MANA
Name	:	DAVID DEPPEN
Credential	:
Telephone Number	:	937-539-8057

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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