Provider Demographics
NPI:1679525208
Name:BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:COZZETTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-276-0344
Mailing Address - Street 1:1620 FORTINO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1856
Mailing Address - Country:US
Mailing Address - Phone:719-542-3555
Mailing Address - Fax:719-542-0425
Practice Address - Street 1:326 DOZIER AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2706
Practice Address - Country:US
Practice Address - Phone:719-276-0344
Practice Address - Fax:719-269-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700048329OtherDR ASHBY NPI
CO44730578Medicaid
CO83707255Medicaid
CO88124088Medicaid
1629078050OtherDR BACK NPI
CO53276060Medicaid
1043277973OtherDR COZZETTA NPI
CO12538248Medicaid
1760476634OtherDR LIPPA NPI
CO71976311Medicaid
1629303631OtherDR FELDMAN NPI
1972555001OtherDR SALDIVIA NPI
1164415345OtherDR WALDMAN NPI
1386874048OtherDR LEWIS NPI
CO39279073Medicaid
1386874048OtherDR LEWIS NPI
CO88124088Medicaid
1972555001OtherDR SALDIVIA NPI
1740412121OtherDR PEDROZA NPI
1760476634OtherDR LIPPA NPI
1164415345OtherDR WALDMAN NPI