Organization
EXECUTIVE PARK EYE CARE, PLLC
Active
Other names
Executive Park Eye Care, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANNE R DERBER O.D. (OWNER/OPTOMETRIST)
(719) 574-7000
Entity
Organization
Contact information
Practice address
9240 EXPLORER DR STE 100, COLORADO SPRINGS, CO 80920-5004
(719) 574-7000
(719) 597-1712
Mailing address
9240 EXPLORER DR STE 100, COLORADO SPRINGS, CO 80920-5004
(719) 574-7000
(719) 597-1712
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27239721
—
CO
Enumeration date
10/11/2006
Last updated
11/02/2021
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