Provider Demographics
NPI:1942403373
Name:ARVADA VISION & EYE CLINIC, P. C.
Entity Type:Organization
Organization Name:ARVADA VISION & EYE CLINIC, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-422-3817
Mailing Address - Street 1:5801 WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-5421
Mailing Address - Country:US
Mailing Address - Phone:303-422-3817
Mailing Address - Fax:303-423-6317
Practice Address - Street 1:5801 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-5421
Practice Address - Country:US
Practice Address - Phone:303-422-3817
Practice Address - Fax:303-423-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO490438Medicare UPIN
CO4901700001Medicare PIN
CO4901700001Medicare NSC
COC490438Medicare PIN