Healthcare Provider Details

I. General information

NPI: 1194021386
Provider Name (Legal Business Name): HERO VISION OF LONGMONT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N MAIN ST
LONGMONT CO
80501-2035
US

IV. Provider business mailing address

2221 E BIJOU ST STE 100
COLORADO SPRINGS CO
80909
US

V. Phone/Fax

Practice location:
  • Phone: 303-834-6400
  • Fax: 303-834-6414
Mailing address:
  • Phone: 303-834-6400
  • Fax: 303-834-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SHAUN URBANOZO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 719-323-2362