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General NPI Number Information
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NPI Number | 1194021386
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Entity Type | Organization
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Legal Business Name | HERO VISION OF LONGMONT, LLC
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 1739 N MAIN ST
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City | LONGMONT
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State | CO
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Zip | 80501-2035
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Country | US
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Telephone | 303-834-6400
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Fax | 303-834-6414
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Provider Business Mailing Address
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Address Line | 2221 E BIJOU ST STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909
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Country | US
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Telephone | 303-834-6400
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Fax | 303-834-6414
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SHAUN URBANOZO
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Credential |
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Telephone | 719-323-2362
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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 |
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License Number State |
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