Provider Demographics
NPI:1659115905
Name:CREATIVE EYEWORKS LLC
Entity type:Organization
Organization Name:CREATIVE EYEWORKS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KONKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-520-6422
Mailing Address - Street 1:100 BROADWAY ST STE 26
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-2734
Mailing Address - Country:US
Mailing Address - Phone:970-522-5294
Mailing Address - Fax:970-522-5294
Practice Address - Street 1:100 BROADWAY ST STE 26
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-2734
Practice Address - Country:US
Practice Address - Phone:970-522-5294
Practice Address - Fax:970-522-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty