Provider Demographics
NPI:1477994036
Name:VICTORY VISION ASSOCIATES, PC
Entity Type:Organization
Organization Name:VICTORY VISION ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-824-8307
Mailing Address - Street 1:2 W VICTORY WAY
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2606
Mailing Address - Country:US
Mailing Address - Phone:970-824-8307
Mailing Address - Fax:970-824-8307
Practice Address - Street 1:2 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2606
Practice Address - Country:US
Practice Address - Phone:970-824-8307
Practice Address - Fax:970-824-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO OPT 1107152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty