Provider Demographics
NPI:1003086463
Name:AMY C CECIL OD PLLC
Entity Type:Organization
Organization Name:AMY C CECIL OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-927-5107
Mailing Address - Street 1:100 ELK RUN DR STE 206
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-9241
Mailing Address - Country:US
Mailing Address - Phone:970-927-5107
Mailing Address - Fax:970-927-5108
Practice Address - Street 1:100 ELK RUN DR STE 206
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9241
Practice Address - Country:US
Practice Address - Phone:970-927-5107
Practice Address - Fax:970-927-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1261152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52027732Medicaid
CO4409690001Medicare NSC
CO52027732Medicaid
U55870Medicare UPIN