Provider Demographics
NPI:1740314483
Name:EYE CARE CENTER OF NORTHERN COLORADO, PC
Entity type:Organization
Organization Name:EYE CARE CENTER OF NORTHERN COLORADO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-772-3300
Mailing Address - Street 1:1400 DRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6505
Mailing Address - Country:US
Mailing Address - Phone:303-772-3300
Mailing Address - Fax:
Practice Address - Street 1:1400 DRY CREEK DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6505
Practice Address - Country:US
Practice Address - Phone:303-772-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCN4108OtherMEDICARE GROUP
CO04018032Medicaid
COCN4108Medicare PIN
COCN4108OtherMEDICARE GROUP