Provider Demographics
NPI:1659544591
Name:ACHZIGER VISION CENTER
Entity Type:Organization
Organization Name:ACHZIGER VISION CENTER
Other - Org Name:MOUNTAIN VISTA VISIONCLINIC AND OPTICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ACHZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-339-9855
Mailing Address - Street 1:1713 61ST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3047
Mailing Address - Country:US
Mailing Address - Phone:970-339-9855
Mailing Address - Fax:970-339-9858
Practice Address - Street 1:1713 61ST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3047
Practice Address - Country:US
Practice Address - Phone:970-339-9855
Practice Address - Fax:970-339-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05906016Medicaid
CO05906016Medicaid
COU96779Medicare UPIN
COC547558Medicare PIN