NPIMap

Organization Active NPI

Altitude Optometry, P.C.

  • Health Service Clinic/Center
  • Boulder, CO
National Provider Identifier
1114154804
Registry record updated Feb 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
2573 Issued in CO
Legal business name
ALTITUDE OPTOMETRY, P.C.
Practice address
1855 29TH St # 1E-1156
Boulder, CO 80301-1065
Phone
(720) 565-0445
Fax
(720) 565-0649
NPI assigned
Jun 19, 2009
Last updated
Feb 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Monica Mortenson, O.D.NPI 1225165335
Title
Optometrist
Phone
(720) 565-0445

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 2573 CO Primary

Addresses

Primary practice location

1855 29TH St # 1E-1156
Boulder, CO 80301-1065

Mailing address

1855 29TH St # 1E-1156
Boulder, CO 80301-1065
Phone (720) 565-0445

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110622000745 CO Part B Supplier - Clinic/Group Practice 9234317298 Receives reassigned benefits from 5 practitioners
Practice locations: Boulder, CO

National Provider Directory

National Provider Directory

Locations

1855 29th St
#1E1156
Boulder, CO 80301
Phone (720) 565-0445

1855 29th St
Unit 1156
Boulder, CO 80301
Phone (720) 565-0445

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1114154804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 29TH ST # 1E-1156",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011065",
            "telephone_number": "720-565-0445",
            "fax_number": "720-565-0649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 29TH ST # 1E-1156",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011065",
            "telephone_number": "720-565-0445",
            "fax_number": "720-565-0649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTITUDE OPTOMETRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-19",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "MORTENSON",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "720-565-0445",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "CO",
            "license": "2573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.