Provider Demographics
NPI:1750613634
Name:COMPREHENSIVE EYE CARE, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUNISHOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-987-9561
Mailing Address - Street 1:625 IVY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-5341
Mailing Address - Country:US
Mailing Address - Phone:720-987-9561
Mailing Address - Fax:303-284-3570
Practice Address - Street 1:3900 E MEXICO AVE
Practice Address - Street 2:#100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3940
Practice Address - Country:US
Practice Address - Phone:303-482-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1235152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1639120363OtherNPI - INDIVIDUAL