Provider Demographics
NPI:1851914824
Name:LO. CO. VISION CONSULTANTS LLC
Entity Type:Organization
Organization Name:LO. CO. VISION CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-769-7877
Mailing Address - Street 1:113 KEEP CIR
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-1372
Mailing Address - Country:US
Mailing Address - Phone:952-769-7877
Mailing Address - Fax:
Practice Address - Street 1:180 KEN PRATT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8974
Practice Address - Country:US
Practice Address - Phone:303-776-4309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty