Provider Demographics
NPI:1699077446
Name:WELLENSIEK EYE CARE, LLC
Entity type:Organization
Organization Name:WELLENSIEK EYE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WELLENSIEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-915-1183
Mailing Address - Street 1:8036 CENTAUR DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-6471
Mailing Address - Country:US
Mailing Address - Phone:303-915-1183
Mailing Address - Fax:
Practice Address - Street 1:1861 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5225
Practice Address - Country:US
Practice Address - Phone:303-237-5401
Practice Address - Fax:303-237-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU69759Medicare UPIN