Provider Demographics
NPI:1164416947
Name:REPINE VISION AND LASER LLC
Entity Type:Organization
Organization Name:REPINE VISION AND LASER LLC
Other - Org Name:COUNTY LINE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-730-8024
Mailing Address - Street 1:8381 SOUTHPARK LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4508
Mailing Address - Country:US
Mailing Address - Phone:303-730-8024
Mailing Address - Fax:303-730-6163
Practice Address - Street 1:8381 SOUTHPARK LN
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4508
Practice Address - Country:US
Practice Address - Phone:303-730-8024
Practice Address - Fax:303-730-6163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REPINE VISION AND LASER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-07
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
40376OtherBLUE CROSS CLUE SHIELD
CO55800068Medicaid
40376OtherBLUE CROSS CLUE SHIELD