| |
711 Harrison Ave Unit H, Leadville, CO 80461-3571 | |
(719) 486-2505 | |
(719) 486-2584 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 711 Harrison Ave Unit H, Leadville, Colorado |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1407050420 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | (* (Not Available)) | Primary |
Provider Name | Robert E Prouty |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1336120724 PECOS PAC ID: 2860411915 Enrollment ID: I20051117000406 |
Mailing Address | Practice Location Address |
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1110 Black Saddle St, Elizabeth, CO 80107-8528 Ph: (720) 252-3802 | 711 Harrison Ave Unit H, Leadville, CO 80461-3571 Ph: (719) 486-2505 |