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General NPI Number Information
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NPI Number | 1881063303
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Entity Type | Organization
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Legal Business Name | 3D VISION, INC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 4080 W NORTHERN AVE
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City | PUEBLO
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State | CO
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Zip | 81005-3503
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Country | US
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Telephone | 719-551-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 4080 W NORTHERN AVE
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City | PUEBLO
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State | CO
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Zip | 81005-3503
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Country | US
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Telephone | 719-551-7337
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNI DRAKE JR.
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Credential |
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Telephone | 719-676-2100
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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.0002603
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License Number State | CO
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