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General NPI Number Information
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NPI Number | 1093233348
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Entity Type | Organization
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Legal Business Name | PARK WEST VISION, LLC
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 3470 PARKER BLVD
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City | PUEBLO
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State | CO
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Zip | 81008
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Country | US
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Telephone | 719-553-7149
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Fax | 719-266-6163
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Provider Business Mailing Address
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Address Line | 3470 PARKER BLVD STE B
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City | PUEBLO
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State | CO
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Zip | 81008-2280
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Country | US
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Telephone | 719-289-2113
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Fax | 719-266-6163
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Authorized Official
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Title or Position | PARTNER
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Name | JOE LEE
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Credential |
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Telephone | 719-289-2113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT0002851
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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