Healthcare Provider Details

I. General information

NPI: 1124666441
Provider Name (Legal Business Name): HERO VISION OF DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3946 MINNESOTA AVE NE
WASHINGTON DC
20019-2661
US

IV. Provider business mailing address

2221 E BIJOU ST STE 100
COLORADO SPRINGS CO
80909-8009
US

V. Phone/Fax

Practice location:
  • Phone: 202-397-1033
  • Fax:
Mailing address:
  • Phone: 719-576-1850
  • Fax:

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: 719-576-1850