Provider Demographics
NPI:1710614896
Name:EAGLE EYECARE PLLC
Entity Type:Organization
Organization Name:EAGLE EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KOCHIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-531-5566
Mailing Address - Street 1:5550 E WOODMEN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-5257
Mailing Address - Country:US
Mailing Address - Phone:719-531-5566
Mailing Address - Fax:719-437-3460
Practice Address - Street 1:5550 E WOODMEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-5257
Practice Address - Country:US
Practice Address - Phone:719-531-5566
Practice Address - Fax:719-437-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center