Provider Demographics
NPI:1548432446
Name:LAFAYETTE EYE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LAFAYETTE EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-665-5441
Mailing Address - Street 1:511 CROSSING DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2628
Mailing Address - Country:US
Mailing Address - Phone:303-665-5441
Mailing Address - Fax:303-665-5473
Practice Address - Street 1:511 CROSSING DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2628
Practice Address - Country:US
Practice Address - Phone:303-665-5441
Practice Address - Fax:303-665-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99136799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF0803Medicare PIN