NPIMap

Organization Active NPI

Rocky Mountain Eye Center Inc a Colorado Provider Network

  • Eyewear Supplier
  • Pueblo, CO
National Provider Identifier
1699837658
Registry record updated Mar 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
ROCKY MOUNTAIN EYE CENTER INC A COLORADO PROVIDER NETWORK
Practice address
3954 Sandalwood LN
Pueblo, CO 81005-2586
Phone
(719) 561-2244
Fax
(719) 561-9329
NPI assigned
Dec 15, 2006
Last updated
Mar 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2015

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

Authorized official

Name
Mr. David Aldag
Title
Administrator
Phone
(719) 545-1530

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU Primary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X NU

Addresses

Primary practice location

3954 Sandalwood LN
Pueblo, CO 81005-2586

Mailing address

27 Montebello Rd
Pueblo, CO 81001-1236
Phone (719) 545-1530

Other identifiers 4

IdentifierTypeStateIssuer
ROK2008OtherCOANTHEM BCBS
04009478MedicaidCO
CQ2139OtherCORAILROAD MEDICARE
CK2008OtherCOMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040629000057 CO Part B Supplier - Clinic/Group Practice 8325942089 Receives reassigned benefits from 16 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pueblo, CO; Salida, CO; Pueblo West, CO; Canon City, CO
O20100930044832 CO DME Supplier - Physician - OptometristDME Supplier - Physician - General Practice 8325942089 Practice locations: Pueblo, CO

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Rocky Mountain Eye Center Inc a Col3954 Sandalwood LN, Pueblo, CO 81005-2586(719) 561-2244 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Mar 18, 1993

National Provider Directory

National Provider Directory
Tax ID family
Rocky Mountain Eye Center Inc a Colorado Provider Network3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

7162 County Road 154
Unit B
Salida, CO 81201
Phone (719) 539-3518

Practitioners & affiliated clinicians

Practitioners 3

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": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1699837658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 MONTEBELLO RD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011236",
            "telephone_number": "719-545-1530",
            "fax_number": "719-545-2899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3954 SANDALWOOD LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052586",
            "telephone_number": "719-561-2244",
            "fax_number": "719-561-9329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN EYE CENTER INC A COLORADO PROVIDER NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "ALDAG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "719-545-1530",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "ROK2008",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04009478",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CQ2139",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CK2008",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.