NPIMap

Organization Active NPI

Marillac Clinic, Inc.

  • Optometrist
  • Grand Junction, CO
National Provider Identifier
1871865576
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MARILLAC CLINIC, INC.
Practice address
2333 N 6TH St
Grand Junction, CO 81501
Phone
(970) 298-2235
Fax
(970) 298-1711
NPI assigned
Jan 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Authorized official

Name
Ms. Lata Ramachandran
Title
Executive Director
Phone
(970) 298-2235

Specialties & licenses 1

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

Addresses

Primary practice location

2333 N 6TH St
Grand Junction, CO 81501

Mailing address

2333 N 6TH St
Grand Junction, CO 81501-2001
Phone (970) 298-2235

Other identifiers 1

IdentifierTypeStateIssuer
37902041MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150105001387 CO Part B Supplier - Clinic/Group Practice 1052634748 Receives reassigned benefits from 18 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Junction, CO; Montrose, CO

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1327622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600646400000",
    "number": "1871865576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 N 6TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012001",
            "telephone_number": "970-298-2235",
            "fax_number": "970-298-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 N 6TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "81501",
            "telephone_number": "970-298-2235",
            "fax_number": "970-298-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILLAC CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-27",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "RAMACHANDRAN",
        "authorized_official_first_name": "LATA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-298-2235",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37902041",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; 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.