Provider Demographics
NPI:1326268921
Name:PARKRIDGE VISION SPECIALISTS, PC
Entity Type:Organization
Organization Name:PARKRIDGE VISION SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-925-0075
Mailing Address - Street 1:9400 STATION ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6808
Mailing Address - Country:US
Mailing Address - Phone:303-925-0075
Mailing Address - Fax:303-925-0079
Practice Address - Street 1:9400 STATION ST
Practice Address - Street 2:SUITE 150
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6808
Practice Address - Country:US
Practice Address - Phone:303-925-0075
Practice Address - Fax:303-925-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2038152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
CO2040152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU78680Medicare UPIN
COU79747Medicare UPIN
CO800621Medicare PIN
CO5755200001Medicare NSC
CO800622Medicare PIN