Healthcare Provider Details

I. General information

NPI: 1457558256
Provider Name (Legal Business Name): BUCKEYE VISION CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 SOUTH UNIVERSITY BLVD. SUITE 102
CENTENNIAL CO
80122-3167
US

IV. Provider business mailing address

7960 SOUTH UNIVERSITY BLVD. SUITE 102
CENTENNIAL CO
80122-3167
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-2345
  • Fax: 303-761-3535
Mailing address:
  • Phone: 303-761-2345
  • Fax: 303-761-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1618
License Number StateCO

VIII. Authorized Official

Name: DR. WALTER FREDERICK MORTON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 303-761-2345