Provider Demographics
NPI:1083148779
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:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:COATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
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 1:1021 N MARKET PLZ STE 110
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1532
Practice Address - Country:US
Practice Address - Phone:719-547-0207
Practice Address - Fax:719-547-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO900151947Medicaid
CO900151947Medicaid