Basic Information
| Provider Information | |||||||||
| NPI: | 1437471414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONE HOUR OPTICAL MEDICAL SERVICES, PC | ||||||||
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| OtherOrganizationName: | EYECARE SPECIALTIES OF COLORADO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1685 S COLORADO BLVD | ||||||||
| Address2: | UNIT O | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037576747 | ||||||||
| FaxNumber: | 3037576897 | ||||||||
| Practice Location | |||||||||
| Address1: | 8547 E ARAPAHOE RD | ||||||||
| Address2: | UNIT H | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801121436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037410446 | ||||||||
| FaxNumber: | 3037410827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2010 | ||||||||
| LastUpdateDate: | 11/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHORT | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALIG MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6184629818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1746 | CO | N | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | S4503 | 01 | CO | MEDICARE PTAN | OTHER | 5668380003 | 01 | CO | MEDICARE DME | OTHER | 04209265 | 05 | CO | MEDICAID |