=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609843390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORRISON OPTOMETRIC ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2006
-----------------------------------------------------
Last Update Date | 05/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1275 ROSE AVE STE A
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80807-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-346-8415
-----------------------------------------------------
Fax | 785-462-2307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 687
-----------------------------------------------------
City | COLBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67701-0687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-462-8231
-----------------------------------------------------
Fax | 785-462-2307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MARY J SHOAFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-462-8231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------