Provider Demographics
NPI:1881063303
Name:3D VISION INC
Entity type:Organization
Organization Name:3D VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:719-551-7337
Mailing Address - Street 1:4080 W NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3503
Mailing Address - Country:US
Mailing Address - Phone:719-551-7337
Mailing Address - Fax:
Practice Address - Street 1:4080 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3503
Practice Address - Country:US
Practice Address - Phone:719-551-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:3D VISION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-15
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0002603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty