Provider Demographics
NPI:1912052523
Name:GREGORY A. VOSSETEIG P.C.
Entity Type:Organization
Organization Name:GREGORY A. VOSSETEIG P.C.
Other - Org Name:2020 VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:VOSSETEIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-490-2020
Mailing Address - Street 1:3501 S SHIELDS ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2583
Mailing Address - Country:US
Mailing Address - Phone:970-490-2020
Mailing Address - Fax:970-221-3121
Practice Address - Street 1:3501 S SHIELDS ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2583
Practice Address - Country:US
Practice Address - Phone:970-490-2020
Practice Address - Fax:970-221-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1613261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00273245OtherRR MEDICARE
CO1220270001OtherDMERC
CO08016131Medicaid
COU45472Medicare UPIN
COC43483Medicare PIN