Provider Demographics
NPI:1376974790
Name:PROFESSIONAL VISION CARE, P.C.
Entity Type:Organization
Organization Name:PROFESSIONAL VISION CARE, P.C.
Other - Org Name:OPTIQUE OF DENVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-540-2307
Mailing Address - Street 1:1580 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1322
Mailing Address - Country:US
Mailing Address - Phone:303-844-3937
Mailing Address - Fax:303-844-3940
Practice Address - Street 1:1580 BLAKE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1322
Practice Address - Country:US
Practice Address - Phone:303-844-3937
Practice Address - Fax:303-844-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2939152W00000X
CO2978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty