Healthcare Provider Details

I. General information

NPI: 1235388026
Provider Name (Legal Business Name): 3-D VISION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8089 S LINCOLN ST SUITE 103
LITTLETON CO
80122-2700
US

IV. Provider business mailing address

8089 S LINCOLN ST SUITE 103
LITTLETON CO
80122-2700
US

V. Phone/Fax

Practice location:
  • Phone: 303-471-2015
  • Fax: 303-471-2042
Mailing address:
  • Phone: 303-471-2015
  • Fax: 303-471-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberCO 1961
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCO 1961
License Number StateCO

VIII. Authorized Official

Name: DIERDRE FOGLE
Title or Position: OWNER DOCTOR
Credential: OD
Phone: 303-471-2015