Provider Demographics
NPI:1669625224
Name:AURORA FAMILY VISION
Entity type:Organization
Organization Name:AURORA FAMILY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-750-0990
Mailing Address - Street 1:2220 S FRASER ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4507
Mailing Address - Country:US
Mailing Address - Phone:303-750-0990
Mailing Address - Fax:303-750-0828
Practice Address - Street 1:2220 S FRASER ST
Practice Address - Street 2:UNIT 2
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4507
Practice Address - Country:US
Practice Address - Phone:303-750-0990
Practice Address - Fax:303-750-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99125699261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center