Provider Demographics
NPI:1629390612
Name:ONE HOUR OPTICAL MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:ONE HOUR OPTICAL MEDICAL SERVICES, PC
Other - Org Name:EYECARE SPECIALTIES OF COLORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-462-9818
Mailing Address - Street 1:1685 S COLORADO BLVD
Mailing Address - Street 2:UNIT O
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4000
Mailing Address - Country:US
Mailing Address - Phone:303-757-6747
Mailing Address - Fax:303-757-6897
Practice Address - Street 1:3867 E 120TH AVE.
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1660
Practice Address - Country:US
Practice Address - Phone:303-450-0200
Practice Address - Fax:303-450-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1746152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06177867Medicaid
CO5668380002OtherMEDICARE DME
COS4503OtherMEDICARE PTAN