Provider Demographics
NPI:1245425800
Name:BETTNER VISION, INC
Entity Type:Organization
Organization Name:BETTNER VISION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-649-1117
Mailing Address - Street 1:9205 N UNION BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7840
Mailing Address - Country:US
Mailing Address - Phone:719-282-0400
Mailing Address - Fax:719-282-1004
Practice Address - Street 1:9205 N UNION BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7840
Practice Address - Country:US
Practice Address - Phone:719-282-0400
Practice Address - Fax:719-282-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU84074Medicare UPIN