Basic Information
| Provider Information | |||||||||
| NPI: | 1134318421 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE CARE CENTER OF NORTHERN COLORADO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 EXEMPLA CIR | ||||||||
| Address2: | STE 120 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800263397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036658766 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 DRY CREEK DR | ||||||||
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| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805036499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036823382 | ||||||||
| FaxNumber: | 3036823380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 02/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOLMS | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3037723300 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EYE CARE CENTER OF NORTHERN COLORADO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.