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General NPI Number Information
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NPI Number | 1801029210
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Entity Type | Organization
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Legal Business Name | YOUR CHILD'S EYES, LLC
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 900 INDIANA AVE STE D
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City | PUEBLO
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State | CO
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Zip | 81004-3767
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Country | US
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Telephone | 719-561-2812
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Fax | 719-561-2056
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Provider Business Mailing Address
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Address Line | 900 INDIANA AVE STE D
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City | PUEBLO
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State | CO
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Zip | 81004-3767
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Country | US
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Telephone | 719-561-2812
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Fax | 719-561-2056
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | DR. MICHAEL GILBERT PHARRIS JR.
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Credential | OD
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Telephone | 719-561-2812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 1462
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License Number State | CO
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