Provider Demographics
NPI:1912374653
Name:COLORADO EYE CENTER, LLC
Entity Type:Organization
Organization Name:COLORADO EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-377-6468
Mailing Address - Street 1:4 GARDEN CTR
Mailing Address - Street 2:STE 100
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7026
Mailing Address - Country:US
Mailing Address - Phone:303-469-1941
Mailing Address - Fax:303-339-6251
Practice Address - Street 1:1485 S COLORADO BLVD
Practice Address - Street 2:STE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3619
Practice Address - Country:US
Practice Address - Phone:303-839-7878
Practice Address - Fax:303-759-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF0403Medicare PIN