Provider Demographics
NPI:1205482031
Name:VISIONARY EYE CARE, PLLC
Entity type:Organization
Organization Name:VISIONARY EYE CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO, FSLS
Authorized Official - Phone:714-932-4766
Mailing Address - Street 1:16860 SHERIDAN PKWY UNIT 106
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8989
Mailing Address - Country:US
Mailing Address - Phone:720-598-2020
Mailing Address - Fax:720-893-9070
Practice Address - Street 1:16860 SHERIDAN PKWY UNIT 106
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8989
Practice Address - Country:US
Practice Address - Phone:720-598-2020
Practice Address - Fax:720-893-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty