Provider Demographics
NPI:1902619091
Name:EYE CARE ASSOCIATES OF CO, LLC
Entity type:Organization
Organization Name:EYE CARE ASSOCIATES OF CO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUETTA
Authorized Official - Middle Name:SHONTA
Authorized Official - Last Name:LATIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-771-3757
Mailing Address - Street 1:230 KINGS HWY E STE 333
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1907
Mailing Address - Country:US
Mailing Address - Phone:877-681-0298
Mailing Address - Fax:
Practice Address - Street 1:2525 S WADSWORTH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3246
Practice Address - Country:US
Practice Address - Phone:303-986-5983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE ASSOCIATES OF CO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-31
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty