Provider Demographics
NPI:1457335077
Name:DENVER EYE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:DENVER EYE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-273-8774
Mailing Address - Street 1:13772 DENVER WEST PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3139
Mailing Address - Country:US
Mailing Address - Phone:303-279-6600
Mailing Address - Fax:303-279-9140
Practice Address - Street 1:13772 DENVER WEST PKWY
Practice Address - Street 2:BLDG#55, STE#120
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3139
Practice Address - Country:US
Practice Address - Phone:303-279-6600
Practice Address - Fax:303-279-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04510087Medicaid
CO427718OtherLEGACY TM
490000347OtherRAILROAD MEDICARE
COCK2878OtherLEGACY JS
CO803688OtherLEGACY NM
CO803092OtherLEGACY RK
COCK2868OtherLEGACY VC
CO803688OtherLEGACY NM
CO04510087Medicaid
CO04510087Medicaid