Provider Demographics
NPI:1225357759
Name:EYE CARE OF COLORADO, P.C.
Entity Type:Organization
Organization Name:EYE CARE OF COLORADO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-478-6645
Mailing Address - Street 1:3256 CAPSTAN WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4536
Mailing Address - Country:US
Mailing Address - Phone:714-478-6645
Mailing Address - Fax:719-266-1735
Practice Address - Street 1:4667 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3304
Practice Address - Country:US
Practice Address - Phone:719-590-1744
Practice Address - Fax:719-266-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810024Medicare PIN