Healthcare Provider Details

I. General information

NPI: 1659318541
Provider Name (Legal Business Name): EYES ONLY VISION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 01/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 HWY 6 & 50 SUITE 110
GRAND JUNCTION CO
81505
US

IV. Provider business mailing address

2464 HWY 6 & 50 SUITE 110
GRAND JUNCTION CO
81505
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-9299
  • Fax: 970-241-1191
Mailing address:
  • Phone: 970-241-9299
  • Fax: 970-241-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. BONNIE JEAN FISKE
Title or Position: CO OWNER
Credential: OD
Phone: 970-241-9299