Southern Colorado Eye Care Associates PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SOUTHERN COLORADO EYE CARE ASSOCIATES PC

Practice address

1620 Fortino Blvd
Pueblo, CO 81008-1856

Phone

(719) 542-3555

NPI assigned

Mar 17, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Michael Ray Cozzetta, O.D.NPI 1043277973

Title

Optometrist/ Owner

Phone

(719) 542-3555

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Practitioners 4

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

• Michael R. Cozzetta, O.D.

  • Optometrist
  • Pueblo, CO
  • NPI 1043277973
  Medicare reassignment Care Compare group Authorized official
• Domenic Cozzetta, OD

  • Optometrist
  • Pueblo, CO
  • NPI 1881242592
  Medicare reassignment Care Compare group NPD
• Jessica Ruxton, OD

  • Optometrist
  • Wichita, KS
  • NPI 1770145385

  CO

  Medicare reassignment Care Compare group NPD
• Derek Wayne Ashby, OD

  • Optometrist
  • Canon City, CO
  • NPI 1700048329
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1679744841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 FORTINO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081856",
            "telephone_number": "719-542-3555",
            "fax_number": "719-542-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 FORTINO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081856",
            "telephone_number": "719-542-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO EYE CARE ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "COZZETTA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OPTOMETRIST/  OWNER",
        "authorized_official_telephone_number": "719-542-3555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1043277973",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08013476",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southern Colorado ENT & Allergy LLC
• Southern Colorado Family Medicine
• Southern Colorado Health & Rehab
• Southern Colorado Health & Rehab
• Southern Colorado Health & Rehab
• Southern Colorado Nephrology Assoc PC

• Optometrist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; 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.