Provider Demographics
NPI:1467639633
Name:EYECARE CENTER OF HIGHLANDS RANCH PC
Entity Type:Organization
Organization Name:EYECARE CENTER OF HIGHLANDS RANCH PC
Other - Org Name:HIGHLANDS RANCH HD EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-794-2020
Mailing Address - Street 1:8677 S QUEBEC ST STE A
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-3052
Mailing Address - Country:US
Mailing Address - Phone:303-794-2020
Mailing Address - Fax:303-794-0500
Practice Address - Street 1:8677 S QUEBEC ST STE A
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-3052
Practice Address - Country:US
Practice Address - Phone:303-794-2020
Practice Address - Fax:303-794-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0551470001Medicare NSC
COC800189Medicare PIN