Provider Demographics
NPI:1336376482
Name:FLATIRONS EYE CARE PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:FLATIRONS EYE CARE PROFESSIONALS, INC.
Other - Org Name:FREDRIC IAN EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:T
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-938-8646
Mailing Address - Street 1:2648 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3542
Mailing Address - Country:US
Mailing Address - Phone:303-938-8646
Mailing Address - Fax:303-938-4087
Practice Address - Street 1:2648 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3542
Practice Address - Country:US
Practice Address - Phone:303-938-8646
Practice Address - Fax:303-938-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 2054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1801867478OtherINDIVIDUAL NPI
COCOB4862Medicare PIN