Provider Demographics
NPI:1396182127
Name:ROCKY MOUNTAIN RETINA ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN RETINA ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEETA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LALCHANDANI-LALWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-900-8507
Mailing Address - Street 1:1330 VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3217
Mailing Address - Country:US
Mailing Address - Phone:303-900-8507
Mailing Address - Fax:303-578-7823
Practice Address - Street 1:1330 VIVIAN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3217
Practice Address - Country:US
Practice Address - Phone:303-900-8507
Practice Address - Fax:303-578-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0051908207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty