Healthcare Provider Details

I. General information

NPI: 1558548354
Provider Name (Legal Business Name): RUNNING CREEK VISION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796 E. KIOWA AVE UNIT H-10
ELIZABETH CO
80107
US

IV. Provider business mailing address

537 PITKIN WAY
CASTLE ROCK CO
80104-3269
US

V. Phone/Fax

Practice location:
  • Phone: 303-646-6911
  • Fax: 303-646-2113
Mailing address:
  • Phone: 303-646-6911
  • Fax: 303-646-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT2313
License Number StateCO

VIII. Authorized Official

Name: CHRISTOPHER THOMAS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 303-646-6911