Provider Demographics
NPI:1386875441
Name:FOUR CORNERS EYE CLINIC, PC
Entity type:Organization
Organization Name:FOUR CORNERS EYE CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-259-2202
Mailing Address - Street 1:575 RIVERGATE LANE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-259-2202
Mailing Address - Fax:970-259-2837
Practice Address - Street 1:190 TALISMAN DR
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-9171
Practice Address - Country:US
Practice Address - Phone:970-259-2202
Practice Address - Fax:970-259-2837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR CORNERS EYE CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-06
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty