Provider Demographics
NPI:1336320670
Name:PREMIER EYE CARE & SURGERY
Entity Type:Organization
Organization Name:PREMIER EYE CARE & SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-282-5467
Mailing Address - Street 1:PO BOX 5493
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5493
Mailing Address - Country:US
Mailing Address - Phone:303-282-5467
Mailing Address - Fax:303-777-7681
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:STE 320
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-282-5467
Practice Address - Fax:303-777-7681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38008174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH43072Medicare UPIN
COC804421Medicare PIN
CODE6234Medicare PIN