Provider Demographics
NPI:1134318421
Name:EYE CARE CENTER OF NORTHERN COLORADO
Entity Type:Organization
Organization Name:EYE CARE CENTER OF NORTHERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-772-3300
Mailing Address - Street 1:300 EXEMPLA CIR
Mailing Address - Street 2:STE 120
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3397
Mailing Address - Country:US
Mailing Address - Phone:303-665-8766
Mailing Address - Fax:
Practice Address - Street 1:1400 DRY CREEK DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6499
Practice Address - Country:US
Practice Address - Phone:303-682-3382
Practice Address - Fax:303-682-3380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE CENTER OF NORTHERN COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-23
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty