Provider Demographics
NPI:1831734656
Name:COCO EYE SURGERY BOULDER, PLLC
Entity type:Organization
Organization Name:COCO EYE SURGERY BOULDER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-531-6073
Mailing Address - Street 1:2575 PEARL ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3851
Mailing Address - Country:US
Mailing Address - Phone:303-442-6260
Mailing Address - Fax:
Practice Address - Street 1:2575 PEARL ST STE 1C
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3851
Practice Address - Country:US
Practice Address - Phone:303-442-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty