Provider Demographics
NPI:1558894451
Name:COCO EYE SURGERY CONSULTING, PLLC
Entity Type:Organization
Organization Name:COCO EYE SURGERY CONSULTING, PLLC
Other - Org Name:HINES SIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-284-7111
Mailing Address - Street 1:2480 S DOWNING ST
Mailing Address - Street 2:STE. G-30
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5890
Mailing Address - Country:US
Mailing Address - Phone:303-777-3277
Mailing Address - Fax:303-698-9713
Practice Address - Street 1:2480 S DOWNING ST
Practice Address - Street 2:STE. G-30
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5890
Practice Address - Country:US
Practice Address - Phone:303-777-3277
Practice Address - Fax:303-698-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0052276207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41770102Medicaid
CO430403YPR3Medicare PIN