Organization
ORCHARD EYE CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLEY R ROUTH CPC (BILLING MANAGER FRONT OFF SUPER)
(970) 243-8697
Entity
Organization
Contact information
Practice address
2403 N 12TH ST, GRAND JUNCTION, CO 81501-8130
(970) 243-8697
(970) 243-8698
Mailing address
2403 N 12TH ST, GRAND JUNCTION, CO 81501-8130
(970) 243-8697
(970) 243-8698
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2476
CO
174400000X
Specialist
Primary
36956
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01369560
—
CO
01
—
634810
BCBS INDIVIDUAL
CO
01
—
917805
SECURE HORIZON
CO
01
—
GEG9008
BCBS GROUP
CO
Enumeration date
12/13/2006
Last updated
04/20/2008
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