Basic Information
| Provider Information | |||||||||
| NPI: | 1093295412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL RANCHO EYE CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6876 SURREY TRL | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801259215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035234305 | ||||||||
| FaxNumber: | 3035261271 | ||||||||
| Practice Location | |||||||||
| Address1: | 952 SWEDE GULCH RD | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804393713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035260534 | ||||||||
| FaxNumber: | 3035261271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | SPEER | ||||||||
| AuthorizedOfficialFirstName: | NEIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3035260534 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2414 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 55335551 | 05 | CO | MEDICAID |