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Organization

MARILLAC CLINIC, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. LATA RAMACHANDRAN (EXECUTIVE DIRECTOR)
(970) 298-2235
Entity
Organization

Contact information

Practice address
2333 N 6TH ST, GRAND JUNCTION, CO 81501
(970) 298-2235
(970) 298-1711
Mailing address
2333 N 6TH ST, GRAND JUNCTION, CO 81501-2001
(970) 298-2235
(970) 298-1711

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
37902041
CO
Enumeration date
01/27/2012
Last updated
09/21/2020
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