Provider Demographics
NPI:1457608341
Name:AMEDCO COLORADO PLLC
Entity Type:Organization
Organization Name:AMEDCO COLORADO PLLC
Other - Org Name:LAKEWOOD EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-237-5401
Mailing Address - Street 1:1861 WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5225
Mailing Address - Country:US
Mailing Address - Phone:303-237-5401
Mailing Address - Fax:303-237-9638
Practice Address - Street 1:1861 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5225
Practice Address - Country:US
Practice Address - Phone:303-237-5401
Practice Address - Fax:303-237-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA3088OtherMEDICARE AMEDCO CO PLLC PTAN