Provider Demographics
NPI:1700068996
Name:KATHLEEN L. VIZE, O.D., P.C.
Entity Type:Organization
Organization Name:KATHLEEN L. VIZE, O.D., P.C.
Other - Org Name:SOUTH UNIVERSITY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:VIZE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-804-5900
Mailing Address - Street 1:7920 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-5103
Mailing Address - Country:US
Mailing Address - Phone:303-804-5900
Mailing Address - Fax:
Practice Address - Street 1:7920 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-5103
Practice Address - Country:US
Practice Address - Phone:303-804-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty