Provider Demographics
NPI:1730299116
Name:OPTOMETRIC ASSOCIATES PC
Entity type:Organization
Organization Name:OPTOMETRIC ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-651-2020
Mailing Address - Street 1:2080 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1916
Mailing Address - Country:US
Mailing Address - Phone:303-651-2020
Mailing Address - Fax:303-776-2460
Practice Address - Street 1:2080 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1916
Practice Address - Country:US
Practice Address - Phone:303-651-2020
Practice Address - Fax:303-776-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008959Medicaid
CO0422000001Medicare NSC
CODG7446Medicare PIN
COCA0003Medicare PIN