Healthcare Provider Details

I. General information

NPI: 1346326626
Provider Name (Legal Business Name): NORTH PARK VISION CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10359 FEDERAL BLVD STE 100
WESTMINSTER CO
80260-7453
US

IV. Provider business mailing address

10359 FEDERAL BLVD STE 100
WESTMINSTER CO
80260-7453
US

V. Phone/Fax

Practice location:
  • Phone: 303-469-7770
  • Fax: 303-469-7772
Mailing address:
  • Phone: 303-469-7770
  • Fax: 303-469-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberOPT-1240
License Number StateCO

VIII. Authorized Official

Name: DR. MARCY ROSE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 303-469-7770