Provider Demographics
NPI:1558026120
Name:TELEOPTOMETRIC SERVICE, CO PC
Entity type:Organization
Organization Name:TELEOPTOMETRIC SERVICE, CO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPEN PANEL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-243-8708
Mailing Address - Street 1:1979 MARCUS AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4759 29TH ST UNIT C
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8380
Practice Address - Country:US
Practice Address - Phone:970-339-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty