Provider Demographics
NPI:1235558065
Name:CARBON VALLEY EYE CARE
Entity Type:Organization
Organization Name:CARBON VALLEY EYE CARE
Other - Org Name:CARBON VALLEY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KODITEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-833-1056
Mailing Address - Street 1:5900 KEYES ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5956
Mailing Address - Country:US
Mailing Address - Phone:303-833-1056
Mailing Address - Fax:303-833-1057
Practice Address - Street 1:5900 KEYES ST STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80504-5956
Practice Address - Country:US
Practice Address - Phone:303-833-1056
Practice Address - Fax:303-833-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty