Provider Demographics
NPI:1659005387
Name:TANNER VISION PC
Entity Type:Organization
Organization Name:TANNER VISION PC
Other - Org Name:PREMIER FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-587-3937
Mailing Address - Street 1:114 14TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-6341
Mailing Address - Country:US
Mailing Address - Phone:970-587-3937
Mailing Address - Fax:970-622-0648
Practice Address - Street 1:114 14TH ST SW
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-6341
Practice Address - Country:US
Practice Address - Phone:970-587-3937
Practice Address - Fax:970-622-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-09
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO2816OtherSTATE LICENSE