Provider Demographics
NPI:1700630720
Name:EYE CARE ASSOCIATES OF CO, LLC
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF CO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:OSNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-452-0344
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-0879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8585 W 14TH AVE STE C
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4860
Practice Address - Country:US
Practice Address - Phone:303-238-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE ASSOCIATES OF CO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty