Madison Street Provider Network INC
Ophthalmology in Fort Collins, CO. Organization (NPI-2).
NPI number1154928331
StatusActive
Last updated in NPPESOct 1, 2020
Details
- NPI
- 1154928331
- Entity type
- Organization (NPI-2)
- Legal business name
- Madison Street Provider Network INC
- Organization subpart
- Yes
- Enumeration date
- Oct 1, 2020
- Certification date
- Oct 1, 2020
- Last updated
- Oct 1, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207W00000X | Ophthalmology | – | – | Yes |
| 152W00000X | Optometrist | – | – |
Other names
- Omni Eye Specialists (Doing Business As)
Practice location
4103 Boardwalk Dr Unit 100Fort Collins, CO 80525-5933
Phone 303-393-8565 · Fax 303-377-2022
Mailing address
Po Box 912914Denver, CO 80291-2914
Authorized official
George L Neal
President
4692140144
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