Provider Demographics
NPI:1689918799
Name:BOULDER EYE CARE PROFESSIONALS LLC
Entity Type:Organization
Organization Name:BOULDER EYE CARE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMONT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-907-2603
Mailing Address - Street 1:2795 PEARL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3826
Mailing Address - Country:US
Mailing Address - Phone:720-565-3031
Mailing Address - Fax:303-444-9488
Practice Address - Street 1:2795 PEARL ST STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3826
Practice Address - Country:US
Practice Address - Phone:720-565-3031
Practice Address - Fax:303-444-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty