Provider Demographics
NPI:1679712236
Name:LOOCK PERFECT IMAGE EYECARE
Entity Type:Organization
Organization Name:LOOCK PERFECT IMAGE EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-471-2244
Mailing Address - Street 1:9559 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7862
Mailing Address - Country:US
Mailing Address - Phone:303-471-2244
Mailing Address - Fax:303-471-4879
Practice Address - Street 1:9559 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7862
Practice Address - Country:US
Practice Address - Phone:303-471-2244
Practice Address - Fax:303-471-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4400Medicare PIN