Provider Demographics
NPI:1922293760
Name:CHILDRENS EYE CENTER PC
Entity Type:Organization
Organization Name:CHILDRENS EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-574-1654
Mailing Address - Street 1:8890 N UNION BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2701
Mailing Address - Country:US
Mailing Address - Phone:719-574-1654
Mailing Address - Fax:719-574-5381
Practice Address - Street 1:4110 BRIARGATE PKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7835
Practice Address - Country:US
Practice Address - Phone:719-574-1654
Practice Address - Fax:719-574-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24447207W00000X
CO42628207W00000X
207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010674Medicaid
COD24451Medicare UPIN
COCS2508Medicare PIN