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General NPI Number Information
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NPI Number | 1811102759
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Entity Type | Organization
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Legal Business Name | NORTH FORK VISION CENTER INC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 210 E. BRIDGE STREET
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City | HOTCHKISS
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State | CO
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Zip | 81419
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Country | US
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Telephone | 970-872-2020
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Fax | 970-872-2022
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Provider Business Mailing Address
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Address Line | PO BOX 658
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City | HOTCHKISS
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State | CO
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Zip | 81419-0658
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Country | US
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Telephone | 970-872-2020
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Fax | 970-872-2022
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE E REDDIN
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Credential | O.D.
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Telephone | 970-872-2020
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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 | 1335
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License Number State | CO
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