Provider Demographics
NPI:1487849907
Name:EYE CARE OF COLORADO, P.C.
Entity Type:Organization
Organization Name:EYE CARE OF COLORADO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:T
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-478-6645
Mailing Address - Street 1:PO BOX 60422
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80960-0422
Mailing Address - Country:US
Mailing Address - Phone:714-478-6645
Mailing Address - Fax:719-260-0094
Practice Address - Street 1:8250 RAZORBACK RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3950
Practice Address - Country:US
Practice Address - Phone:719-260-8230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810025Medicare PIN