Provider Demographics
NPI:1013121987
Name:CENTER FOR EYE CARE & SURGERY PC
Entity Type:Organization
Organization Name:CENTER FOR EYE CARE & SURGERY PC
Other - Org Name:OPTICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-546-3937
Mailing Address - Street 1:1501 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2722
Mailing Address - Country:US
Mailing Address - Phone:719-546-3937
Mailing Address - Fax:719-546-3940
Practice Address - Street 1:1501 COURT ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2722
Practice Address - Country:US
Practice Address - Phone:719-546-3937
Practice Address - Fax:719-546-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25573332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1316087117OtherCENTER FOR EYE CARE NPI
CO04014601Medicaid
CO1912991514OtherJAMES B. FOWLER NPI
CO04014601Medicaid