MEDICARE: SOUTHERN COLORADO FAMILY EYE CARE, PC

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	:	1881134963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN COLORADO FAMILY EYE CARE, PC

Provider Business Mailing Address
First Line	:	727 S BEAR PAW LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3220
Country	:	US
Telephone Number	:	719-391-2317
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 VENETUCCI BLVD
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80906-4013
Country	:	US
Telephone Number	:	719-576-1049
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JIRO KAMEOKA
Credential	:	OD
Telephone Number	:	719-576-1049

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/17/2017

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