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General NPI Number Information
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NPI Number | 1467889329
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Entity Type | Organization
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Legal Business Name | WINROCK VISION INC
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 8370 NORTHFIELD BLVD 1795
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City | DENVER
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State | CO
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Zip | 80238-3132
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Country | US
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Telephone | 303-373-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 714 W WILLOW ST
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City | LOUISVILLE
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State | CO
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Zip | 80027-1032
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Country | US
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Telephone | 760-285-4165
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNIFER BLAUROCK
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Credential | O.D.
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Telephone | 760-285-4165
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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 | 2975
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License Number State | CO
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