Organization
MADISON STREET PROVIDER NETWORK INC
Active
Organization
MADISON STREET PROVIDER NETWORK INC
Active
Other names
Omni Eye Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE L NEAL (PRESIDENT & SECRETARY)
(469) 214-0144
Entity
Organization
Contact information
Practice address
55 MADISON ST STE 355, DENVER, CO 80206-5429
(303) 377-2020
(303) 377-2022
Mailing address
55 MADISON ST STE 355, DENVER, CO 80206-5429
(303) 377-2020
(303) 377-2022
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
CO
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04012274
—
CO
05
—
12832278
—
CO
Enumeration date
08/25/2005
Last updated
10/15/2020
Update your record
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