Provider Demographics
NPI:1467889329
Name:WINROCK VISION INC
Entity Type:Organization
Organization Name:WINROCK VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAUROCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-285-4165
Mailing Address - Street 1:714 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1032
Mailing Address - Country:US
Mailing Address - Phone:760-285-4165
Mailing Address - Fax:
Practice Address - Street 1:8370 NORTHFIELD BLVD
Practice Address - Street 2:1795
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3132
Practice Address - Country:US
Practice Address - Phone:303-373-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2975152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty