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General NPI Number Information
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NPI Number | 1760721724
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Entity Type | Organization
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Legal Business Name | COLORADO VISION CENTER P C
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 1300 BARLOW RD
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City | FORT MORGAN
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State | CO
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Zip | 80701-4363
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Country | US
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Telephone | 970-542-2291
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Fax | 970-542-2294
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Provider Business Mailing Address
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Address Line | 1718 68TH AVE
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City | GREELEY
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State | CO
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Zip | 80634-8654
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Country | US
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Telephone | 970-542-2291
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Fax | 970-542-2294
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Authorized Official
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Title or Position | OFFICER/OWNER
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Name | DR. CRAIG ASMUSSEN
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Credential | OD
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Telephone | 970-542-2291
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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 | OPT 1389
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License Number State | CO
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