Provider Demographics
NPI:1265822621
Name:ROCKY MOUNTAIN EYE CENTER, INC. A COLORADO PROVIDER NETWORK
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN EYE CENTER, INC. A COLORADO PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:COATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-545-1530
Mailing Address - Street 1:27 MONTEBELLO ROAD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1236
Mailing Address - Country:US
Mailing Address - Phone:719-545-1530
Mailing Address - Fax:719-545-2899
Practice Address - Street 1:608 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-2136
Practice Address - Country:US
Practice Address - Phone:719-738-3937
Practice Address - Fax:719-738-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty