Provider Demographics
NPI:1144599044
Name:EYE SPECIALISTS OF COLORADO
Entity Type:Organization
Organization Name:EYE SPECIALISTS OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EYE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-440-0058
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0280
Mailing Address - Country:US
Mailing Address - Phone:719-633-8000
Mailing Address - Fax:719-434-8855
Practice Address - Street 1:3245 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3152
Practice Address - Country:US
Practice Address - Phone:719-633-8000
Practice Address - Fax:719-434-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89074572Medicaid
CO89074572Medicaid
COCK9218Medicare PIN
COCK9218Medicare PIN