Provider Demographics
NPI:1922090844
Name:NATURAL EYES LASER AND SURGERY CENTER, LLLP
Entity Type:Organization
Organization Name:NATURAL EYES LASER AND SURGERY CENTER, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-634-2001
Mailing Address - Street 1:2485 E. PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-634-2001
Mailing Address - Fax:719-634-2211
Practice Address - Street 1:2485 E. PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLO. SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-634-2001
Practice Address - Fax:719-634-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160559261Q00000X
CO0304261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01218890Medicaid
COX52379Medicare UPIN
COCA61059Medicare ID - Type Unspecified