Provider Demographics
NPI:1689192924
Name:YOUTH VISION OF AURORA, LLC
Entity Type:Organization
Organization Name:YOUTH VISION OF AURORA, LLC
Other - Org Name:AURORA YOUTH DENTAL & VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-200-5653
Mailing Address - Street 1:14251 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8706
Mailing Address - Country:US
Mailing Address - Phone:303-343-3133
Mailing Address - Fax:303-343-3139
Practice Address - Street 1:14251 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8706
Practice Address - Country:US
Practice Address - Phone:303-343-3133
Practice Address - Fax:719-960-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000152116Medicaid