NPIMap

Organization Active NPI

Madison Street Provider Network Inc

  • Ophthalmology Physician
  • Fort Collins, CO
National Provider Identifier
1154928331
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MADISON STREET PROVIDER NETWORK INC
Practice address
4103 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5933
Phone
(303) 393-8565
Fax
(303) 377-2022
NPI assigned
Oct 1, 2020
Organization subpart
Yes
Parent organization
MADISON STREET PROVIDER NETWORK INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Authorized official

Name
George L Neal
Title
President
Phone
(469) 214-0144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

4103 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5933

Mailing address

PO Box 912914
Denver, CO 80291-2914

Other names 1

  • Omni Eye Specialists Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Madison St Provider Network10 organizations share this tax ID, including this one
Part of
Madison St Provider Network

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1154928331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 912914",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802912914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 BOARDWALK DR UNIT 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255933",
            "telephone_number": "303-393-8565",
            "fax_number": "303-377-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON STREET PROVIDER NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MADISON STREET PROVIDER NETWORK INC",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-214-0144"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Eye Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.