Provider Demographics
NPI:1447201009
Name:GLAUCOMA CONSULTANTS OF COLORADO, PC
Entity Type:Organization
Organization Name:GLAUCOMA CONSULTANTS OF COLORADO, PC
Other - Org Name:SPECIALTY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:E.
Authorized Official - Middle Name:RANDY
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-794-1111
Mailing Address - Street 1:11960 LIONESS WAY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5640
Mailing Address - Country:US
Mailing Address - Phone:303-794-1111
Mailing Address - Fax:303-347-1341
Practice Address - Street 1:11960 LIONESS WAY
Practice Address - Street 2:SUITE 190
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5640
Practice Address - Country:US
Practice Address - Phone:303-794-1111
Practice Address - Fax:303-347-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04018099Medicaid
COC485398Medicare PIN
6381510001Medicare NSC