Provider Demographics
NPI:1043959430
Name:3D VISION INC
Entity Type:Organization
Organization Name:3D VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:CORINNE
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-404-3937
Mailing Address - Street 1:4491 BENT BROTHERS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLORADO CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4491 BENT BROTHERS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019
Practice Address - Country:US
Practice Address - Phone:719-676-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:3D VISION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41932064Medicaid