Provider Demographics
NPI:1801561634
Name:EVERGREEN OPTOMETRY, PLLC
Entity type:Organization
Organization Name:EVERGREEN OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:BREANNE
Authorized Official - Last Name:NOLASCO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-403-0991
Mailing Address - Street 1:PO BOX 63780
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-3780
Mailing Address - Country:US
Mailing Address - Phone:719-403-0991
Mailing Address - Fax:
Practice Address - Street 1:15 SPECTRUM LOOP
Practice Address - Street 2:SUITE 125
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921
Practice Address - Country:US
Practice Address - Phone:719-661-0287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty