Provider Demographics
NPI:1659318541
Name:EYES ONLY VISION CARE LLC
Entity Type:Organization
Organization Name:EYES ONLY VISION CARE LLC
Other - Org Name:EYES FIRST VISION CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FISKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-241-9299
Mailing Address - Street 1:2464 HWY 6 & 50
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-241-9299
Mailing Address - Fax:970-241-1191
Practice Address - Street 1:2464 HWY 6 & 50
Practice Address - Street 2:SUITE 110
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-241-9299
Practice Address - Fax:970-241-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC486078Medicare PIN