Provider Demographics
NPI:1720203862
Name:RETINA CONSULTANTS OF SOUTHERN COLORADO P C
Entity Type:Organization
Organization Name:RETINA CONSULTANTS OF SOUTHERN COLORADO P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-473-9595
Mailing Address - Street 1:2770 N UNION BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1183
Mailing Address - Country:US
Mailing Address - Phone:719-473-9595
Mailing Address - Fax:719-227-0669
Practice Address - Street 1:2770 N UNION BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1183
Practice Address - Country:US
Practice Address - Phone:719-473-9595
Practice Address - Fax:719-227-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28079207W00000X
CO38699207W00000X
CO42148207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCB1408Medicare ID - Type Unspecified