Provider Demographics
NPI:1811076466
Name:EYE SPECIALISTS OF COLORADO LLC
Entity type:Organization
Organization Name:EYE SPECIALISTS OF COLORADO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNEROPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DEWEY
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-633-8000
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0280
Mailing Address - Country:US
Mailing Address - Phone:719-440-0058
Mailing Address - Fax:719-636-3223
Practice Address - Street 1:3245 INTERNATIONAL CIR STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3152
Practice Address - Country:US
Practice Address - Phone:719-633-8000
Practice Address - Fax:719-434-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 156F00000X, 174400000X
CO188207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015764Medicaid
CO04015764Medicaid
COD23506Medicare UPIN
CO1042940001Medicare NSC
COCK9218Medicare PIN
CO1042940001Medicare NSC
COCK9218Medicare PIN