Provider Demographics
NPI:1891204517
Name:FOUNDERS PARKWAY VISION CENTER, PC
Entity Type:Organization
Organization Name:FOUNDERS PARKWAY VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:AUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-623-8200
Mailing Address - Street 1:4344 WOODLANDS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2801
Mailing Address - Country:US
Mailing Address - Phone:303-688-3636
Mailing Address - Fax:
Practice Address - Street 1:4344 WOODLANDS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2801
Practice Address - Country:US
Practice Address - Phone:303-688-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.1446332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies