Provider Demographics
NPI:1114132644
Name:ABBA EYE CARE PC
Entity Type:Organization
Organization Name:ABBA EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-219-3819
Mailing Address - Street 1:1200 E CAMPBELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1963
Mailing Address - Country:US
Mailing Address - Phone:314-741-8183
Mailing Address - Fax:314-741-4947
Practice Address - Street 1:314 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3608
Practice Address - Country:US
Practice Address - Phone:719-384-2020
Practice Address - Fax:719-384-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015491Medicaid
CO04015491Medicaid
CO0727840006Medicare NSC