Provider Demographics
NPI:1073998837
Name:GREELEY EYE DOCTORS
Entity Type:Organization
Organization Name:GREELEY EYE DOCTORS
Other - Org Name:LOVELAND EYE DOCTORS
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-339-1825
Mailing Address - Street 1:3103 S 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-8702
Mailing Address - Country:US
Mailing Address - Phone:970-339-1825
Mailing Address - Fax:970-339-1837
Practice Address - Street 1:3632 W 10TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-1851
Practice Address - Country:US
Practice Address - Phone:970-339-1825
Practice Address - Fax:970-339-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT00002949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO282582OtherMEDICARE PTAN
CO61988529Medicaid