Provider Demographics
NPI:1346326626
Name:NORTH PARK VISION CENTER, P.C.
Entity Type:Organization
Organization Name:NORTH PARK VISION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-469-7770
Mailing Address - Street 1:10359 FEDERAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-7453
Mailing Address - Country:US
Mailing Address - Phone:303-469-7770
Mailing Address - Fax:303-469-7772
Practice Address - Street 1:10359 FEDERAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80260-7453
Practice Address - Country:US
Practice Address - Phone:303-469-7770
Practice Address - Fax:303-469-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT-1240302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOPT-1240OtherLICENSE # MARCY ROSE
COOPT-1895OtherLICENSE # CHRISTINE BEST
COOPT-1572OtherLICENSE # T. VAN WILSON
COOPT-1240OtherLICENSE # MARCY ROSE