Provider Demographics
NPI:1740471622
Name:EYE CARE FOR DURANGO, LLC
Entity type:Organization
Organization Name:EYE CARE FOR DURANGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEW-GOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-385-1935
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302
Mailing Address - Country:US
Mailing Address - Phone:970-385-1935
Mailing Address - Fax:
Practice Address - Street 1:1155 S CAMINO DEL RIO
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6698
Practice Address - Country:US
Practice Address - Phone:970-385-1935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty