Provider Demographics
NPI:1598979023
Name:ABBA EYE CARE INC
Entity Type:Organization
Organization Name:ABBA EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-219-3819
Mailing Address - Street 1:1130 LAKE PLAZA DRIVE
Mailing Address - Street 2:SUITE #230
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-219-3819
Mailing Address - Fax:719-219-0411
Practice Address - Street 1:6110 MARTINEZ ST
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-2048
Practice Address - Country:US
Practice Address - Phone:719-368-2446
Practice Address - Fax:719-576-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015491Medicaid
CO04015491Medicaid