Provider Demographics
NPI:1760692768
Name:COLORADO RIVER EYE CARE, PC
Entity Type:Organization
Organization Name:COLORADO RIVER EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-758-2020
Mailing Address - Street 1:2840 HIWAY 95
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7792
Mailing Address - Country:US
Mailing Address - Phone:958-758-2020
Mailing Address - Fax:928-758-4544
Practice Address - Street 1:2840 HIWAY 95
Practice Address - Street 2:SUITE 108
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7792
Practice Address - Country:US
Practice Address - Phone:958-758-2020
Practice Address - Fax:928-758-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1285694174OtherNPI
AZ1154381879OtherNPI
AZ1760692768OtherNPI
AZ1154381879OtherNPI
AZZ114997Medicare PIN
AZT88152Medicare UPIN
AZV12360Medicare UPIN
AZZ114980Medicare PIN