Basic Information
| Provider Information | |||||||||
| NPI: | 1447384862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE LASER CENTER OF NORTHERN COLORADO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 E PROSPECT RD | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805251307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704192667 | ||||||||
| FaxNumber: | 9702214286 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 E PROSPECT RD | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805251307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704192667 | ||||||||
| FaxNumber: | 9702214286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | KINCHER | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DEPT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9702212222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS0132X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ophthalmologic Surgery |
No ID Information.