Provider Demographics
NPI:1003015819
Name:INNOVATIVE EYECARE, INC
Entity Type:Organization
Organization Name:INNOVATIVE EYECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HANKENSON
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:303-840-4949
Mailing Address - Street 1:18741 PONDEROSA DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-8812
Mailing Address - Country:US
Mailing Address - Phone:303-840-4949
Mailing Address - Fax:303-840-0184
Practice Address - Street 1:18741 PONDEROSA DR
Practice Address - Street 2:SUITE D
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-8812
Practice Address - Country:US
Practice Address - Phone:303-840-4949
Practice Address - Fax:303-840-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1884152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty