Provider Demographics
NPI:1679187850
Name:ALTITUDE EYE CARE AT CASTLEROCK, PLLC
Entity Type:Organization
Organization Name:ALTITUDE EYE CARE AT CASTLEROCK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:COLEEN
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-480-4711
Mailing Address - Street 1:6380 PROMENADE PKWY STE A-100
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-1909
Mailing Address - Country:US
Mailing Address - Phone:720-475-9991
Mailing Address - Fax:720-475-6590
Practice Address - Street 1:6380 PROMENADE PKWY STE A100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-1909
Practice Address - Country:US
Practice Address - Phone:720-475-9991
Practice Address - Fax:720-457-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty