Provider Demographics
NPI:1245783240
Name:ROCKY MOUNTAIN EYE INSTITUTE, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN EYE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLDREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-263-0027
Mailing Address - Street 1:1645 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1645 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1001
Practice Address - Country:US
Practice Address - Phone:303-443-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0001465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty