Provider Demographics
NPI:1194548271
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:SHONTA
Authorized Official - Last Name:LATIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-771-3757
Mailing Address - Street 1:230 KINGS HWY E STE 333
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:877-681-0298
Practice Address - Street 1:2249 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3147
Practice Address - Country:US
Practice Address - Phone:970-669-4587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty