Healthcare Provider Details

I. General information

NPI: 1033710066
Provider Name (Legal Business Name): BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 S MONACO PKWY
DENVER CO
80222-5814
US

IV. Provider business mailing address

326 DOZIER AVE
CANON CITY CO
81212-2706
US

V. Phone/Fax

Practice location:
  • Phone: 303-476-6233
  • Fax:
Mailing address:
  • Phone: 719-276-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER KILLEN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 719-276-0344