Provider Demographics
NPI:1134334220
Name:ABBA EYE CARE PC
Entity type:Organization
Organization Name:ABBA EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-219-3819
Mailing Address - Street 1:1200 E CAMPBELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1963
Mailing Address - Country:US
Mailing Address - Phone:314-741-8183
Mailing Address - Fax:314-741-4947
Practice Address - Street 1:2800 CORNERSTONE DR STE A6
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8157
Practice Address - Country:US
Practice Address - Phone:970-731-4300
Practice Address - Fax:970-731-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015491Medicaid
CO0727840010Medicare NSC
COCF1203Medicare ID - Type Unspecified