Provider Demographics
NPI:1548215346
Name:SUMMIT EYE CENTER PC
Entity Type:Organization
Organization Name:SUMMIT EYE CENTER PC
Other - Org Name:KIRK EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:970-669-1107
Mailing Address - Street 1:3650 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8701
Mailing Address - Country:US
Mailing Address - Phone:970-669-1107
Mailing Address - Fax:970-669-8849
Practice Address - Street 1:3650 E 15TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8701
Practice Address - Country:US
Practice Address - Phone:970-669-1107
Practice Address - Fax:970-669-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99143599152W00000X, 332B00000X
CO28606207W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04012829Medicaid
COCG9108Medicare PIN
CO04012829Medicaid
CODC8236Medicare PIN