Healthcare Provider Details

I. General information

NPI: 1871755041
Provider Name (Legal Business Name): BAYFIELD FAMILY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 WOLVERINE DR # 5
BAYFIELD CO
81122-9653
US

IV. Provider business mailing address

480 WOLVERINE DR # 5
BAYFIELD CO
81122-9653
US

V. Phone/Fax

Practice location:
  • Phone: 970-884-6188
  • Fax: 970-884-2869
Mailing address:
  • Phone: 970-884-6188
  • Fax: 970-884-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2532
License Number StateCO

VIII. Authorized Official

Name: DR. JONATHAN E ZISSMAN
Title or Position: CO-OWNER
Credential: OD
Phone: 970-884-6188