Provider Demographics
NPI:1508948829
Name:VISION CLINIC OF GREELEY P C
Entity Type:Organization
Organization Name:VISION CLINIC OF GREELEY P C
Other - Org Name:VISION CLINIC AT FOXHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:OD
Authorized Official - Phone:970-330-7070
Mailing Address - Street 1:2001 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3250
Mailing Address - Country:US
Mailing Address - Phone:970-330-7070
Mailing Address - Fax:970-330-8382
Practice Address - Street 1:2001 46TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3250
Practice Address - Country:US
Practice Address - Phone:970-330-7070
Practice Address - Fax:970-330-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1962152W00000X
CO799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04767430Medicaid
CO04767430Medicaid
COCF0103Medicare PIN