Provider Demographics
NPI:1447384862
Name:EYE LASER CENTER OF NORTHERN COLORADO LLC
Entity Type:Organization
Organization Name:EYE LASER CENTER OF NORTHERN COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-2222
Mailing Address - Street 1:1725 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1307
Mailing Address - Country:US
Mailing Address - Phone:970-419-2667
Mailing Address - Fax:970-221-4286
Practice Address - Street 1:1725 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1307
Practice Address - Country:US
Practice Address - Phone:970-419-2667
Practice Address - Fax:970-221-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery