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EXECUTIVE PARK EYE CARE PLLC NPI 1528156734


NPI Information

NPI: 1528156734
Provider Name: EXECUTIVE PARK EYE CARE, PLLC

Former Legal Business Name: EXECUTIVE PARK EYE CARE, LLC

Classification: Optometrist - 152W00000X
Entity Type: Organization

CLIA Number: 06D2101311

Address:
9240 EXPLORER DR STE 100
COLORADO SPRINGS, CO
ZIP 80920
Phone: (719) 574-7000
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EXECUTIVE PARK EYE CARE, PLLC is an optometrist in Colorado Springs, CO. The provider is doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. EXECUTIVE PARK EYE CARE, PLLC NPI is 1528156734. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Executive Park Eye Care, Llc.

The provider's business location address is:

9240 EXPLORER DR STE 100
COLORADO SPRINGS, CO
ZIP 80920-004
Phone: (719) 574-7000
Fax: (719) 597-1712

The provider's authorized official is Jeanne R Derber .
The authorized official title is Owner/optometrist and has the following contact phone number (719) 574-7000.

The CLIA number assigned to this NPI record is 06D2101311 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/11/2006 and was last updated on 11/2/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1152W00000XOptometristYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
127239721MEDICAIDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.