Healthcare Provider Details

I. General information

NPI: 1467889329
Provider Name (Legal Business Name): WINROCK VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8370 NORTHFIELD BLVD 1795
DENVER CO
80238-3132
US

IV. Provider business mailing address

714 W WILLOW ST
LOUISVILLE CO
80027-1032
US

V. Phone/Fax

Practice location:
  • Phone: 303-373-1700
  • Fax:
Mailing address:
  • Phone: 760-285-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2975
License Number StateCO

VIII. Authorized Official

Name: DR. JENNIFER BLAUROCK
Title or Position: PRESIDENT
Credential: O.D.
Phone: 760-285-4165