Provider Demographics
NPI:1851534705
Name:MORRISON OPTOMETRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:MORRISON OPTOMETRIC ASSOCIATES, PA
Other - Org Name:VISION SOURCE OF BURLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-462-8231
Mailing Address - Street 1:498 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1624
Mailing Address - Country:US
Mailing Address - Phone:719-346-8415
Mailing Address - Fax:
Practice Address - Street 1:498 15TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1624
Practice Address - Country:US
Practice Address - Phone:719-346-8415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS8632OtherRAILROAD MEDICARE
CO76557758Medicaid
CS8632OtherRAILROAD MEDICARE
CO0381270004Medicare NSC