Provider Demographics
NPI:1265027437
Name:COLORADO WEST OPHTHALMOLOGY ASSOC. PC
Entity Type:Organization
Organization Name:COLORADO WEST OPHTHALMOLOGY ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-249-1210
Mailing Address - Street 1:1800 E PAVILION PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5499
Mailing Address - Country:US
Mailing Address - Phone:970-249-1210
Mailing Address - Fax:970-249-3057
Practice Address - Street 1:1426 MESA VIEW DR
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2400
Practice Address - Country:US
Practice Address - Phone:970-874-8821
Practice Address - Fax:970-874-3472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO WEST OPHTHALMOLOGY ASSOC. PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCJ7703OtherRAILROAD MEDICARE
CO98604OtherBLUE CROSS BLUE SHIELD
CO9000132032Medicaid