Provider Demographics
NPI:1093295412
Name:EL RANCHO EYE CARE, LLC
Entity Type:Organization
Organization Name:EL RANCHO EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-526-0534
Mailing Address - Street 1:6876 SURREY TRL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-9215
Mailing Address - Country:US
Mailing Address - Phone:303-523-4305
Mailing Address - Fax:303-526-1271
Practice Address - Street 1:952 SWEDE GULCH RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-3713
Practice Address - Country:US
Practice Address - Phone:303-526-0534
Practice Address - Fax:303-526-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55335551Medicaid