Provider Demographics
NPI:1104287374
Name:ASCENT PLLC
Entity type:Organization
Organization Name:ASCENT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-751-2834
Mailing Address - Street 1:12311 PINE BLUFFS WAY UNIT 108
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7402
Mailing Address - Country:US
Mailing Address - Phone:262-751-2834
Mailing Address - Fax:888-317-1023
Practice Address - Street 1:12311 PINE BLUFFS WAY
Practice Address - Street 2:#108
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:262-751-2834
Practice Address - Fax:888-317-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
CO2702261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01490Medicare UPIN