Provider Demographics
NPI:1801029210
Name:YOUR CHILD'S EYES, LLC
Entity Type:Organization
Organization Name:YOUR CHILD'S EYES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:PHARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:719-561-2812
Mailing Address - Street 1:900 INDIANA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3767
Mailing Address - Country:US
Mailing Address - Phone:719-561-2812
Mailing Address - Fax:719-561-2056
Practice Address - Street 1:900 INDIANA AVE STE D
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3767
Practice Address - Country:US
Practice Address - Phone:719-561-2812
Practice Address - Fax:719-561-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1462152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty