Healthcare Provider Details

I. General information

NPI: 1811102759
Provider Name (Legal Business Name): NORTH FORK VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E. BRIDGE STREET
HOTCHKISS CO
81419
US

IV. Provider business mailing address

PO BOX 658
HOTCHKISS CO
81419-0658
US

V. Phone/Fax

Practice location:
  • Phone: 970-872-2020
  • Fax: 970-872-2022
Mailing address:
  • Phone: 970-872-2020
  • Fax: 970-872-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1335
License Number StateCO

VIII. Authorized Official

Name: DIANE E REDDIN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 970-872-2020