Provider Demographics
NPI:1326399254
Name:EYE CARE PROFESSIONAL LLC
Entity type:Organization
Organization Name:EYE CARE PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-505-6411
Mailing Address - Street 1:15802 E PRINCETON PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2556
Mailing Address - Country:US
Mailing Address - Phone:720-505-6411
Mailing Address - Fax:
Practice Address - Street 1:20921 E SMOKY HILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5120
Practice Address - Country:US
Practice Address - Phone:303-942-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO275491Medicare PIN