Provider Demographics
NPI:1275725889
Name:TILLMAN EYE CARE GROUP, INC
Entity Type:Organization
Organization Name:TILLMAN EYE CARE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-373-1700
Mailing Address - Street 1:8370 NORTHFIELD BLVD
Mailing Address - Street 2:SUITE 1795
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3132
Mailing Address - Country:US
Mailing Address - Phone:303-373-1700
Mailing Address - Fax:
Practice Address - Street 1:8370 NORTHFIELD BLVD
Practice Address - Street 2:SUITE 1795
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3132
Practice Address - Country:US
Practice Address - Phone:303-373-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2012152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC809343Medicare UPIN