Healthcare Provider Details

I. General information

NPI: 1164416947
Provider Name (Legal Business Name): REPINE VISION AND LASER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8381 SOUTHPARK LN
LITTLETON CO
80120-4508
US

IV. Provider business mailing address

8381 SOUTHPARK LN
LITTLETON CO
80120-4508
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8024
  • Fax: 303-730-6163
Mailing address:
  • Phone: 303-730-8024
  • Fax: 303-730-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. NORA PEARSON
Title or Position: OPTICIAN
Credential:
Phone: 303-730-8024