Provider Demographics
NPI:1639221674
Name:COLORADO WEST OPHTHALMOLOGY ASSOC. PC
Entity Type:Organization
Organization Name:COLORADO WEST OPHTHALMOLOGY ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-249-1210
Mailing Address - Street 1:1800 E PAVILION PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5499
Mailing Address - Country:US
Mailing Address - Phone:970-249-1210
Mailing Address - Fax:970-249-3057
Practice Address - Street 1:1800 E. PAVILION PLACE
Practice Address - Street 2:SUITE B
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-249-1210
Practice Address - Fax:970-249-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04001491Medicaid
98604OtherBLUE CROSS BLUESHIELD
CJ7703OtherRAILROAD MEDICARE
CO04001491Medicaid
CO04001491Medicaid