Healthcare Provider Details

I. General information

NPI: 1164805628
Provider Name (Legal Business Name): CHRISTINA GROSSHANS, OD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 W DRAKE RD SUITE 3
FORT COLLINS CO
80526-2881
US

IV. Provider business mailing address

373 W DRAKE RD SUITE 3
FORT COLLINS CO
80526-2881
US

V. Phone/Fax

Practice location:
  • Phone: 970-223-7150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3116
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number3116
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3116
License Number StateCO

VIII. Authorized Official

Name: DR. CHRISTINA GROSSHANS
Title or Position: MANAGER/SOLE MEMBER
Credential: OD
Phone: 818-468-2809