Provider Demographics
NPI:1679153076
Name:RUNNING CREEK VISION CENTER
Entity Type:Organization
Organization Name:RUNNING CREEK VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-219-7721
Mailing Address - Street 1:8505 PARK MEADOWS CENTER DR STE 2213
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5067
Mailing Address - Country:US
Mailing Address - Phone:303-565-7019
Mailing Address - Fax:303-568-6380
Practice Address - Street 1:8505 PARK MEADOWS CENTER DR STE 2213
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5067
Practice Address - Country:US
Practice Address - Phone:303-565-7019
Practice Address - Fax:303-568-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52155056Medicaid
COOPT0002313OtherCO STATE LICENSE