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General NPI Number Information
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NPI Number | 1992940530
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Entity Type | Organization
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Legal Business Name | WAZNY VISION PC
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 3190 S WADSWORTH BLVD SUITE 320
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City | LAKEWOOD
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State | CO
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Zip | 80227-4899
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Country | US
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Telephone | 303-988-5858
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Fax | 303-988-3651
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Provider Business Mailing Address
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Address Line | 3190 S WADSWORTH BLVD SUITE 320
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City | LAKEWOOD
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State | CO
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Zip | 80227-4899
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Country | US
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Telephone | 303-988-5858
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Fax | 303-988-3651
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL WAZNY I
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Credential | OD
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Telephone | 303-988-5858
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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 | 1017
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License Number State | CO
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