Provider Demographics
NPI:1619960580
Name:LOOMIS, YOUNT, PETERSON & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:LOOMIS, YOUNT, PETERSON & ASSOCIATES, PLLC
Other - Org Name:MOUNTAIN VISTA EYECARE AND DRY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-979-4505
Mailing Address - Street 1:7761 SHAFFER PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3731
Mailing Address - Country:US
Mailing Address - Phone:303-979-4505
Mailing Address - Fax:303-933-0714
Practice Address - Street 1:7761 SHAFFER PKWY
Practice Address - Street 2:STE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-3731
Practice Address - Country:US
Practice Address - Phone:303-979-4505
Practice Address - Fax:303-933-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCK8660OtherRAILROAD MEDICARE
COC370708Medicare PIN
COCK8660Medicare PIN
COT60850Medicare UPIN
CO0433480001Medicare NSC
COU32813Medicare UPIN
COV06522Medicare UPIN
COT87567Medicare UPIN