Provider Demographics
NPI:1265049266
Name:MBO VISION INC
Entity type:Organization
Organization Name:MBO VISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAZIANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-722-5535
Mailing Address - Street 1:18148 W 92ND LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-8164
Mailing Address - Country:US
Mailing Address - Phone:720-722-5535
Mailing Address - Fax:
Practice Address - Street 1:18148 W 92ND LN
Practice Address - Street 2:SUITE 400
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-8164
Practice Address - Country:US
Practice Address - Phone:720-722-5535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty