1417192121 NPI number — THE UNCOMPAHGRE VALLEY VISION CENTER

Table of content: (NPI 1417192121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417192121 NPI number — THE UNCOMPAHGRE VALLEY VISION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE UNCOMPAHGRE VALLEY VISION CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417192121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 S 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-5719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-249-3183
Provider Business Mailing Address Fax Number:
970-240-9438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 S 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81401-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-249-3183
Provider Business Practice Location Address Fax Number:
970-240-9438
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CERTIFIED OPTICIAN
Authorized Official Telephone Number:
970-249-3183

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  008114 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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