Provider Demographics
NPI:1639517766
Name:ENVISION DURANGO LLC
Entity type:Organization
Organization Name:ENVISION DURANGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-382-8790
Mailing Address - Street 1:2855 MAIN AVE
Mailing Address - Street 2:STE A103
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5956
Mailing Address - Country:US
Mailing Address - Phone:970-382-8790
Mailing Address - Fax:970-382-8966
Practice Address - Street 1:2855 MAIN AVE
Practice Address - Street 2:STE A103
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5956
Practice Address - Country:US
Practice Address - Phone:970-382-8790
Practice Address - Fax:970-382-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2948152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty