Provider Demographics
NPI:1104689165
Name:EYE CARE ASSOCIATES OF CO LLC
Entity type:Organization
Organization Name:EYE CARE ASSOCIATES OF CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-204-5326
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-0879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1534 28TH AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-7602
Practice Address - Country:US
Practice Address - Phone:515-573-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE ASSOCIATES OF CO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty