NPIMap

Organization Active NPI

Rocky Mountain Eye Center, Inc. a Colorado Provider Network

  • Optometrist
  • Canon City, CO
National Provider Identifier
1831251891
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ROCKY MOUNTAIN EYE CENTER, INC. A COLORADO PROVIDER NETWORK
Practice address
901 Sell Ave
Canon City, CO 81212-4900
Phone
(719) 275-7481
Fax
(719) 275-0059
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 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
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X
Eyewear Supplier 332H00000X

Addresses

Primary practice location

901 Sell Ave
Canon City, CO 81212-4900

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
608439600OtherCOU S DEPARTMENT OF LABOR
ROK2008OtherCOANTHEM BLUE CROSS BLUE SH
CK2008OtherCOMEDICARE
04009478MedicaidCO
CQ2139OtherCORAILROAD MEDICARE

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
O20100930082433 CO DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 8325942089 Practice locations: Canon City, 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 Col901 Sell Ave, Canon City, CO 81212-4974(719) 275-7481 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

901 Sell Ave
Canon City, CO 81212
Phone (719) 275-7481

Practitioners & affiliated clinicians

Practitioners 5

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

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": "1450396800000",
    "number": "1831251891",
    "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": "901 SELL AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124900",
            "telephone_number": "719-275-7481",
            "fax_number": "719-275-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN EYE CENTER, INC. A COLORADO PROVIDER NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2015-12-18",
        "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": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U S DEPARTMENT OF LABOR",
            "identifier": "608439600",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SH",
            "identifier": "ROK2008",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CK2008",
            "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"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.