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General NPI Number Information
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NPI Number | 1295871069
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Entity Type | Organization
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Legal Business Name | PONDEROSA VISION CLINIC, PC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8101 E LOWRY BLVD #110
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City | DENVER
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State | CO
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Zip | 80230-7196
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Country | US
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Telephone | 303-671-0000
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Fax | 303-671-2879
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Provider Business Mailing Address
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Address Line | 14991 E HAMPDEN AVE #110
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City | AURORA
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State | CO
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Zip | 80014-3983
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Country | US
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Telephone | 303-693-9561
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Fax | 303-693-0713
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN ALLEN BRYANT
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Credential | O.D.
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Telephone | 303-693-9561
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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 | 960
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License Number State | CO
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