Collegiate Peaks Eyecare PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3040 Issued in CO

Legal business name

COLLEGIATE PEAKS EYECARE PLLC

Practice address

421 Hwy 24 S
Buena Vista, CO 81211-3179

Phone

(719) 581-4060

Fax

(719) 631-2577

NPI assigned

Aug 12, 2014

Organization subpart

No

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

Authorized official

Name

Matthew L Scott, O.D.NPI 1932105467

Title

Manager

Phone

(719) 581-4060

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO2 enrollments

Enrollment records 2

Locations

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew L Scott, O.D.

  • Optometrist
  • Buena Vista, CO
  • NPI 1932105467

  CO, Optometrist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1184033490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3179",
            "city": "BUENA VISTA",
            "state": "CO",
            "postal_code": "812113179",
            "telephone_number": "719-581-4060",
            "fax_number": "719-631-2577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 HWY 24 S",
            "city": "BUENA VISTA",
            "state": "CO",
            "postal_code": "812113179",
            "telephone_number": "719-581-4060",
            "fax_number": "719-631-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGIATE PEAKS EYECARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-12",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "719-581-4060",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "3040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46203770",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Buena Vista, CO
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; 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.