Provider Demographics
NPI:1417192121
Name:THE UNCOMPAHGRE VALLEY VISION CENTER
Entity Type:Organization
Organization Name:THE UNCOMPAHGRE VALLEY VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-249-3183
Mailing Address - Street 1:314 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5719
Mailing Address - Country:US
Mailing Address - Phone:970-249-3183
Mailing Address - Fax:970-240-9438
Practice Address - Street 1:314 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5719
Practice Address - Country:US
Practice Address - Phone:970-249-3183
Practice Address - Fax:970-240-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO008114332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1286710001Medicare NSC