Provider Demographics
NPI:1326032418
Name:CORNEAL CONSULTANTS OF COLORADO PC
Entity Type:Organization
Organization Name:CORNEAL CONSULTANTS OF COLORADO PC
Other - Org Name:COUNTY LINE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-730-0404
Mailing Address - Street 1:1501 W MINERAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5612
Mailing Address - Country:US
Mailing Address - Phone:303-730-8024
Mailing Address - Fax:303-730-6163
Practice Address - Street 1:1501 W MINERAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5612
Practice Address - Country:US
Practice Address - Phone:303-730-8024
Practice Address - Fax:303-730-6163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNEAL CONSULTANTS OF COLORADO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-06
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04005146Medicaid
CB4508OtherBLUE CROSS BLUE SHIELD
0273150001Medicare NSC