Provider Demographics
NPI:1386600104
Name:COLORADO SPRINGS EYE SURGERY CENTER
Entity type:Organization
Organization Name:COLORADO SPRINGS EYE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-636-3937
Mailing Address - Street 1:2920 N CASCADE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6262
Mailing Address - Country:US
Mailing Address - Phone:719-636-5054
Mailing Address - Fax:719-580-3576
Practice Address - Street 1:2920 N CASCADE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6262
Practice Address - Country:US
Practice Address - Phone:719-636-5054
Practice Address - Fax:719-580-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4510004Medicaid
CO490001964OtherRAILROAD MEDICARE
COCO00357OtherBLUE CROSS BLUE SHIELD
COCO00357OtherBLUE CROSS BLUE SHIELD
CO490001964OtherRAILROAD MEDICARE