Provider Demographics
NPI:1497856017
Name:ARVADA EYECARE LLC
Entity type:Organization
Organization Name:ARVADA EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANSUR
Authorized Official - Middle Name:
Authorized Official - Last Name:NURDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-424-2991
Mailing Address - Street 1:16205 W 64TH AVE
Mailing Address - Street 2:#100
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7401
Mailing Address - Country:US
Mailing Address - Phone:303-424-2991
Mailing Address - Fax:303-467-2486
Practice Address - Street 1:16205 W 64TH AVE
Practice Address - Street 2:#100
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7401
Practice Address - Country:US
Practice Address - Phone:303-424-2991
Practice Address - Fax:303-467-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04403771Medicaid
COC528728Medicare PIN
3892840001Medicare NSC