Provider Demographics
NPI:1952002248
Name:EYE CENTER OF NORTHERN COLORADO, P.C
Entity type:Organization
Organization Name:EYE CENTER OF NORTHERN COLORADO, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZDRALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-713-1025
Mailing Address - Street 1:1725 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 ERIE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-4072
Practice Address - Country:US
Practice Address - Phone:720-933-6615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD J KELLER MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty