Provider Demographics
NPI:1508994641
Name:WESTERN ROCKIES EYE CENTER,P.C.
Entity Type:Organization
Organization Name:WESTERN ROCKIES EYE CENTER,P.C.
Other - Org Name:WESTERN ROCKIES OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-243-9000
Mailing Address - Street 1:2460 PATTERSON RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1027
Mailing Address - Country:US
Mailing Address - Phone:197-245-1514
Mailing Address - Fax:970-245-4936
Practice Address - Street 1:2460 PATTERSON RD UNIT 2
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1027
Practice Address - Country:US
Practice Address - Phone:190-245-1514
Practice Address - Fax:970-245-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
CO3578332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55432310Medicaid
CO0454430001Medicare NSC