Provider Demographics
NPI:1710160718
Name:EYE CARE CENTER OF COLORADO SPRINGS
Entity Type:Organization
Organization Name:EYE CARE CENTER OF COLORADO SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-576-5844
Mailing Address - Street 1:110 S WEBER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1908
Mailing Address - Country:US
Mailing Address - Phone:719-576-5844
Mailing Address - Fax:719-576-6955
Practice Address - Street 1:110 S WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-576-5844
Practice Address - Fax:719-576-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT60846Medicare UPIN
CO4379630001Medicare NSC
COC445448Medicare PIN
CODC9706Medicare PIN