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General NPI Number Information
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NPI Number | 1942802483
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Entity Type | Organization
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Legal Business Name | VIRGINIA VISION CARE ASSOC., L.L.C.
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 250 W 65TH ST
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City | LOVELAND
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State | CO
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Zip | 80538-4668
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Country | US
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Telephone | 970-381-2539
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Fax |
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Provider Business Mailing Address
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Address Line | 2416 PURDUE RD
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City | FORT COLLINS
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State | CO
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Zip | 80525-1711
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Country | US
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Telephone | 970-825-3554
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | EWING R MCCLELLAND
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Credential | OD
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Telephone | 720-825-3554
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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 |
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License Number State |
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