Provider Demographics
NPI:1083756605
Name:STERLING EYE CENTER,LLP
Entity Type:Organization
Organization Name:STERLING EYE CENTER,LLP
Other - Org Name:
Other - Org Type:
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:970-522-1833
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:970-522-1833
Mailing Address - Fax:970-522-3677
Practice Address - Street 1:220 S 3RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4258
Practice Address - Country:US
Practice Address - Phone:970-522-1833
Practice Address - Fax:970-522-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008264Medicaid
COSTD508OtherBLUE CROSS & BLUE SHIELD
CO04008264Medicaid
NE=========00Medicaid
COCDO508Medicare PIN
CO04008264Medicaid