Provider Demographics
NPI:1942408737
Name:MOUNTAIN VIEW VISION, PC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW VISION, PC
Other - Org Name:MOUNTAIN VIEW VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TADA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-380-6808
Mailing Address - Street 1:7435 SISTERS GROVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2604
Mailing Address - Country:US
Mailing Address - Phone:719-380-6808
Mailing Address - Fax:719-380-5656
Practice Address - Street 1:7435 SISTERS GROVE
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2604
Practice Address - Country:US
Practice Address - Phone:719-380-6808
Practice Address - Fax:719-380-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2048152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODT4447OtherRAILROAD MEDICARE PTAN
CO01330357Medicaid
CO50057227Medicaid
CODT4447OtherRAILROAD MEDICARE PTAN
CO6228970001Medicare NSC