Provider Demographics
NPI:1205533445
Name:HOLISTIC EYE CARE CENTER OF THE ROCKIES, LLC
Entity type:Organization
Organization Name:HOLISTIC EYE CARE CENTER OF THE ROCKIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-513-1233
Mailing Address - Street 1:1225 KEN PRATT BLVD UNIT 120
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9001
Mailing Address - Country:US
Mailing Address - Phone:720-513-1233
Mailing Address - Fax:720-302-0443
Practice Address - Street 1:1225 KEN PRATT BLVD UNIT 120
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9001
Practice Address - Country:US
Practice Address - Phone:720-513-1233
Practice Address - Fax:720-302-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty