=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326268921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKRIDGE VISION SPECIALISTS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 09/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9400 STATION ST SUITE 150
-----------------------------------------------------
City | LONETREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-6808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-925-0075
-----------------------------------------------------
Fax | 303-925-0079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9400 STATION ST SUITE 150
-----------------------------------------------------
City | LONETREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-6808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-925-0075
-----------------------------------------------------
Fax | 303-925-0079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRES
-----------------------------------------------------
Name | DR. MICHELLE SANCHO
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 303-925-0075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2040
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 2038
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 2040
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 152WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Optometrist
-----------------------------------------------------
License Number | 2038
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 152WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Optometrist
-----------------------------------------------------
License Number | 2040
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 152WS0006X
-----------------------------------------------------
Taxonomy Name | Sports Vision Optometrist
-----------------------------------------------------
License Number | 2038
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2038
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------