Provider Demographics
NPI:1518214311
Name:PIERRE ANCTIL. OD PC
Entity Type:Organization
Organization Name:PIERRE ANCTIL. OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANCTIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-632-3561
Mailing Address - Street 1:1625 E PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5620
Mailing Address - Country:US
Mailing Address - Phone:719-632-3561
Mailing Address - Fax:719-633-0284
Practice Address - Street 1:1625 E PLATTE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5620
Practice Address - Country:US
Practice Address - Phone:719-632-3561
Practice Address - Fax:719-633-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1113152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7200950001Medicare NSC
CO78003Medicare PIN
COT60836Medicare UPIN