Provider Demographics
NPI:1760418156
Name:FRONT RANGE EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:FRONT RANGE EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-951-1820
Mailing Address - Street 1:13605 XAVIER LN
Mailing Address - Street 2:SUITE G
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-3603
Mailing Address - Country:US
Mailing Address - Phone:303-951-1820
Mailing Address - Fax:303-951-1826
Practice Address - Street 1:13605 XAVIER LN
Practice Address - Street 2:SUITE G
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-3603
Practice Address - Country:US
Practice Address - Phone:303-951-1820
Practice Address - Fax:303-951-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC805687Medicare PIN
CO6078930002Medicare NSC