Provider Demographics
NPI:1134180110
Name:GEORGIS, JAMES F (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:GEORGIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CLUB MANOR DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1601
Mailing Address - Country:US
Mailing Address - Phone:719-542-7325
Mailing Address - Fax:719-542-6290
Practice Address - Street 1:22 CLUB MANOR DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1601
Practice Address - Country:US
Practice Address - Phone:719-542-7325
Practice Address - Fax:719-542-6290
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO410029089OtherRAILROAD MEDICARE
CO0438610001OtherMEDICARE DMERC
CO0438610001OtherMEDICARE DMERC