Provider Demographics
NPI:1447794409
Name:REDSTONE EYE CARE
Entity Type:Organization
Organization Name:REDSTONE EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-881-8899
Mailing Address - Street 1:1200 S HOVER ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7902
Mailing Address - Country:US
Mailing Address - Phone:303-845-4215
Mailing Address - Fax:303-682-8181
Practice Address - Street 1:1200 S HOVER ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7902
Practice Address - Country:US
Practice Address - Phone:303-845-4215
Practice Address - Fax:303-682-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty