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General NPI Number Information
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NPI Number | 1679525208
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Entity Type | Organization
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Legal Business Name | BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 326 DOZIER AVE
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City | CANON CITY
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State | CO
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Zip | 81212-2706
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Country | US
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Telephone | 719-276-0344
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Fax | 719-269-7446
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Provider Business Mailing Address
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Address Line | 1620 FORTINO BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-1856
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Country | US
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Telephone | 719-542-3555
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Fax | 719-542-0425
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL R COZZETTA
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Credential | O.D.
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Telephone | 719-276-0344
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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 | 1347
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License Number State | CO
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