Provider Demographics
NPI:1841885894
Name:ROARING FORK VISION PLLC
Entity type:Organization
Organization Name:ROARING FORK VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-927-2020
Mailing Address - Street 1:PO BOX 27257
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-0257
Mailing Address - Country:US
Mailing Address - Phone:970-927-2020
Mailing Address - Fax:
Practice Address - Street 1:341 MARKET ST
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-7409
Practice Address - Country:US
Practice Address - Phone:970-927-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty