Provider Demographics
NPI:1093891244
Name:WILLIAM G SELF JR MD PC
Entity Type:Organization
Organization Name:WILLIAM G SELF JR MD PC
Other - Org Name:EYE SURGERY CENTER OF COLORADO PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-920-2685
Mailing Address - Street 1:8403 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3809
Mailing Address - Country:US
Mailing Address - Phone:303-426-4810
Mailing Address - Fax:303-426-8708
Practice Address - Street 1:8403 BRYANT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3809
Practice Address - Country:US
Practice Address - Phone:303-426-4810
Practice Address - Fax:303-426-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017513Medicaid
COCN6824OtherRAILROAD MEDICARE
COC87304Medicare PIN