Provider Demographics
NPI:1477690394
Name:ASSOCIATED EYE CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ASSOCIATED EYE CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-671-0000
Mailing Address - Street 1:8101 E LOWRY BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7121
Mailing Address - Country:US
Mailing Address - Phone:303-671-0000
Mailing Address - Fax:303-367-2256
Practice Address - Street 1:8101 E LOWRY BLVD STE 255
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7121
Practice Address - Country:US
Practice Address - Phone:303-671-0000
Practice Address - Fax:303-367-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3917460001Medicare NSC