Provider Demographics
NPI:1891991758
Name:ROCKY MOUNTAIN EYE CENTER, INC., A COLORADO PROVIDER NETWORK
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN EYE CENTER, INC., A COLORADO PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:COATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-545-1530
Mailing Address - Street 1:27 MONTEBELLO ROAD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1236
Mailing Address - Country:US
Mailing Address - Phone:719-545-1530
Mailing Address - Fax:719-545-2899
Practice Address - Street 1:305 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-1704
Practice Address - Country:US
Practice Address - Phone:719-254-7404
Practice Address - Fax:719-254-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9994499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0711970002Medicare NSC