Healthcare Provider Details

I. General information

NPI: 1215392527
Provider Name (Legal Business Name): PEAK VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 DILLON RIDGE ROAD
DILLON CO
80435
US

IV. Provider business mailing address

PO BOX 402
DILLON CO
80435-0402
US

V. Phone/Fax

Practice location:
  • Phone: 419-356-8757
  • Fax:
Mailing address:
  • Phone: 419-356-8757
  • Fax: 970-368-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number0001118
License Number StateCO

VIII. Authorized Official

Name: STEPHEN BELANGER
Title or Position: OWNER
Credential: OD
Phone: 419-356-8757