Provider Demographics
NPI:1114962651
Name:CHILDREN'S EYE PHYSICIANS P.C.
Entity Type:Organization
Organization Name:CHILDREN'S EYE PHYSICIANS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-463-5784
Mailing Address - Street 1:4875 WARD RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1942
Mailing Address - Country:US
Mailing Address - Phone:303-456-9456
Mailing Address - Fax:303-463-7560
Practice Address - Street 1:4875 WARD RD
Practice Address - Street 2:SUITE 600
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1942
Practice Address - Country:US
Practice Address - Phone:303-456-9456
Practice Address - Fax:303-463-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010328Medicaid
COCF2308Medicare PIN