Healthcare Provider Details

I. General information

NPI: 1669932679
Provider Name (Legal Business Name): COLORADO VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 N ACADEMY BLVD
COLORADO SPRINGS CO
80909-6605
US

IV. Provider business mailing address

320 E FONTANERO ST STE 201
COLORADO SPRINGS CO
80907-7525
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-3300
  • Fax:
Mailing address:
  • Phone: 719-559-2020
  • Fax: 719-632-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BLAKE SIMMONS
Title or Position: PRESIDENT
Credential: OD
Phone: 719-559-2020