Provider Demographics
NPI:1326378209
Name:EYE ON LIVING, INC.
Entity Type:Organization
Organization Name:EYE ON LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ZEKERT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CLVT
Authorized Official - Phone:303-543-0669
Mailing Address - Street 1:PO BOX 3251
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80307-3251
Mailing Address - Country:US
Mailing Address - Phone:303-543-0669
Mailing Address - Fax:303-494-0530
Practice Address - Street 1:610 S 40TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5905
Practice Address - Country:US
Practice Address - Phone:303-543-0669
Practice Address - Fax:303-494-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6310855Medicaid
S944757Medicare UPIN