Provider Demographics
NPI:1386301315
Name:EYES ON BELMAR LLC
Entity type:Organization
Organization Name:EYES ON BELMAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-655-4960
Mailing Address - Street 1:6255 QUEBEC PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-4812
Mailing Address - Country:US
Mailing Address - Phone:305-613-7250
Mailing Address - Fax:
Practice Address - Street 1:6255 QUEBEC PKWY STE 1100
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-4812
Practice Address - Country:US
Practice Address - Phone:303-655-4960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty