Provider Demographics
NPI:1710563705
Name:FAMILY FIRST VISION CARE COLORADO LLC
Entity Type:Organization
Organization Name:FAMILY FIRST VISION CARE COLORADO LLC
Other - Org Name:WEST POINT OPTICAL GROUP LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANDERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-236-7067
Mailing Address - Street 1:316 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3350
Mailing Address - Country:US
Mailing Address - Phone:904-545-4465
Mailing Address - Fax:
Practice Address - Street 1:2795 PEARL ST STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3826
Practice Address - Country:US
Practice Address - Phone:720-680-0225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty