Provider Demographics
NPI:1194133827
Name:MONTGOMERY EYE CARE PC
Entity type:Organization
Organization Name:MONTGOMERY EYE CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIEGLINDE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-252-9981
Mailing Address - Street 1:10465 MELODY DR
Mailing Address - Street 2:STE 111
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4119
Mailing Address - Country:US
Mailing Address - Phone:303-252-9981
Mailing Address - Fax:303-252-7306
Practice Address - Street 1:10465 MELODY DR
Practice Address - Street 2:STE 111
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4119
Practice Address - Country:US
Practice Address - Phone:303-252-9981
Practice Address - Fax:303-252-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160496261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF69054Medicare UPIN