Provider Demographics
NPI:1073559605
Name:EYE CENTER OF NORTHERN COLORADO, P.C.
Entity Type:Organization
Organization Name:EYE CENTER OF NORTHERN COLORADO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-2222
Mailing Address - Street 1:1725 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1307
Mailing Address - Country:US
Mailing Address - Phone:970-221-2222
Mailing Address - Fax:970-221-4286
Practice Address - Street 1:1725 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1307
Practice Address - Country:US
Practice Address - Phone:970-221-2222
Practice Address - Fax:970-221-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04775045Medicaid
CO04775045Medicaid