Healthcare Provider Details

I. General information

NPI: 1033637046
Provider Name (Legal Business Name): ALPENGLOW EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 24 RD
GRAND JUNCTION CO
81505-1240
US

IV. Provider business mailing address

747 GLEN CT UNIT 40
GRAND JUNCTION CO
81506-8285
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-5412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2747
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2747
License Number StateCO

VIII. Authorized Official

Name: TRAVIS ANDERSON
Title or Position: OPTOMETRIST
Credential:
Phone: 307-760-4866