Provider Demographics
NPI:1073567459
Name:ROCKY MOUNTAIN EYE CENTER INC A COLORADO PROVIDER NETWORK
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN EYE CENTER INC A COLORADO PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HULETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-545-1530
Mailing Address - Street 1:27 MONTEBELLO RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1236
Mailing Address - Country:US
Mailing Address - Phone:719-545-1530
Mailing Address - Fax:719-545-2899
Practice Address - Street 1:27 MONTEBELLO RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1236
Practice Address - Country:US
Practice Address - Phone:719-545-1530
Practice Address - Fax:719-545-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04009478Medicaid
NM85432067Medicaid
NMCK7367OtherRAILROAD MEDICARE
COROK2008OtherANTHEM BCBS
COCK2008OtherMEDICARE
COCQ2139OtherRAILROAD MEDICARE