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General NPI Number Information
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NPI Number | 1184747230
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Entity Type | Organization
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Legal Business Name | MONTE VISTA EYE CARE CENTER INC.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 101 CHICO CT
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City | MONTE VISTA
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State | CO
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Zip | 81144-1067
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Country | US
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Telephone | 719-852-3412
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Fax | 719-852-3345
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Provider Business Mailing Address
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Address Line | 101 CHICO CT
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City | MONTE VISTA
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State | CO
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Zip | 81144-1067
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Country | US
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Telephone | 719-852-3412
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Fax | 719-852-3345
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL WILLIAM HEERSINK
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Credential | O.D.
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Telephone | 719-852-3412
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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 | 990
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License Number State | CO
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