Provider Demographics
NPI:1568620805
Name:SPEX OPTICAL AND FOOTHILLS EYE CARE, PC
Entity Type:Organization
Organization Name:SPEX OPTICAL AND FOOTHILLS EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SKRDLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-282-7739
Mailing Address - Street 1:712 WHALERS WAY
Mailing Address - Street 2:STE A 210
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3630
Mailing Address - Country:US
Mailing Address - Phone:970-282-7739
Mailing Address - Fax:970-226-6654
Practice Address - Street 1:712 WHALERS WAY
Practice Address - Street 2:STE A 210
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3630
Practice Address - Country:US
Practice Address - Phone:970-282-7739
Practice Address - Fax:970-226-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802812Medicare PIN