Provider Demographics
NPI:1043353980
Name:STERLING EYE CENTER,LLP
Entity Type:Organization
Organization Name:STERLING EYE CENTER,LLP
Other - Org Name:VISUAL OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DERMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-522-1836
Mailing Address - Street 1:P O BOX 951
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4258
Mailing Address - Country:US
Mailing Address - Phone:970-522-1836
Mailing Address - Fax:970-522-3677
Practice Address - Street 1:220 S 3RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4258
Practice Address - Country:US
Practice Address - Phone:970-522-1836
Practice Address - Fax:970-522-3677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STERLING EYE CENTER, L.L.P.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008264Medicaid
COVID0508OtherBLUE CROSS & BLUE SHIELD
CO=========0000EOtherCORPORATE BENEFIT SERVICE
CO04008264Medicaid
COVID0508OtherBLUE CROSS & BLUE SHIELD
NE=========00Medicaid
COCDO508Medicare PIN