Provider Demographics
NPI:1598530750
Name:OUT THERE EYECARE LLC
Entity Type:Organization
Organization Name:OUT THERE EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:BALLARD
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-431-6078
Mailing Address - Street 1:10990 COUNTY ROAD 28
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:CO
Mailing Address - Zip Code:80744-9430
Mailing Address - Country:US
Mailing Address - Phone:970-522-9192
Mailing Address - Fax:970-522-5953
Practice Address - Street 1:1510 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-9095
Practice Address - Country:US
Practice Address - Phone:970-522-9095
Practice Address - Fax:970-522-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty