Provider Demographics
NPI:1851621767
Name:EYES ON BRECKENRIDGE, INC
Entity Type:Organization
Organization Name:EYES ON BRECKENRIDGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVAGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-453-6910
Mailing Address - Street 1:PO BOX 4654
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-4654
Mailing Address - Country:US
Mailing Address - Phone:970-453-6910
Mailing Address - Fax:970-547-5865
Practice Address - Street 1:216 SOUTH MAIN ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-4654
Practice Address - Country:US
Practice Address - Phone:970-453-6910
Practice Address - Fax:970-547-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty