Provider Demographics
NPI:1942072194
Name:SOCO OPHTHALMOLOGY LLC
Entity Type:Organization
Organization Name:SOCO OPHTHALMOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-391-0549
Mailing Address - Street 1:1520 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7433
Mailing Address - Country:US
Mailing Address - Phone:801-391-0549
Mailing Address - Fax:719-934-9657
Practice Address - Street 1:5755 MARK DABLING BLVD STE 190
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2228
Practice Address - Country:US
Practice Address - Phone:719-257-3959
Practice Address - Fax:719-934-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease