=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245425800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETTNER VISION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2007
-----------------------------------------------------
Last Update Date | 11/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9205 N UNION BLVD STE 110
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-7840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-282-0400
-----------------------------------------------------
Fax | 719-282-1004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9205 N UNION BLVD STE 110
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-7840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-282-0400
-----------------------------------------------------
Fax | 719-282-1004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTOPHER ALAN BETTNER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 719-649-1117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1734
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------