Provider Demographics
NPI:1740233642
Name:BELLEVIEW EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BELLEVIEW EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEILANI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PHILLIPS-BORSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-979-3937
Mailing Address - Street 1:5104 S FIELD ST
Mailing Address - Street 2:STE. C
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7308
Mailing Address - Country:US
Mailing Address - Phone:303-979-3937
Mailing Address - Fax:866-881-3396
Practice Address - Street 1:5104 S FIELD ST
Practice Address - Street 2:STE. C
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7308
Practice Address - Country:US
Practice Address - Phone:303-979-3937
Practice Address - Fax:866-881-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO106943OtherBLOCK LOCATION ID NUMBER
CO106943OtherBLOCK LOCATION ID NUMBER
CO805234Medicare PIN