Provider Demographics
NPI:1356512628
Name:ASPEN EYE CENTER, LLC
Entity type:Organization
Organization Name:ASPEN EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONGLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-586-4418
Mailing Address - Street 1:600 S SAINT VRAIN AVE
Mailing Address - Street 2:#5
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-7488
Mailing Address - Country:US
Mailing Address - Phone:970-586-4418
Mailing Address - Fax:
Practice Address - Street 1:600 S SAINT VRAIN AVE
Practice Address - Street 2:#5
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-7488
Practice Address - Country:US
Practice Address - Phone:970-586-4418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO2195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC448508Medicare PIN
CO4436580001Medicare NSC
COT 71267Medicare UPIN