Provider Demographics
NPI:1699816751
Name:EYE VISION OPTICAL,INC.
Entity Type:Organization
Organization Name:EYE VISION OPTICAL,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TALYAI
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:303-534-8811
Mailing Address - Street 1:1551 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-2908
Mailing Address - Country:US
Mailing Address - Phone:303-534-8811
Mailing Address - Fax:303-825-0109
Practice Address - Street 1:1551 CHAMPA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-2908
Practice Address - Country:US
Practice Address - Phone:303-534-8811
Practice Address - Fax:303-825-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2292093156FC0800X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14600749Medicaid
MD20551OtherSPECTERA-UNITED HEALTH
OHOP0608OtherEYEMED
CO=========OtherVCPN
OHOP0608OtherEYEMED
MD20551OtherSPECTERA-UNITED HEALTH
=========OtherGREATWEST