| |
1725 S Pueblo Blvd, Pueblo, CO 81005-2103 | |
(719) 281-2633 | |
(719) 281-2634 |
Full Name | |
---|---|
Type | Facility |
Speciality | Clinic/center |
Location | 1725 S Pueblo Blvd, Pueblo, Colorado |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1700247228 | NPI | - | NPPES |
68820071 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
2221 E Bijou St, Ste 100, Colorado Springs, CO 80909 Ph: (719) 281-2633 | 1725 S Pueblo Blvd, Pueblo, CO 81005-2103 Ph: (719) 281-2633 |