MEDICARE: 3D VISION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1053541854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3D VISION, INC

Provider Business Mailing Address
First Line	:	400 N SANTA FE AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-4136
Country	:	US
Telephone Number	:	215-870-4624
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N SANTA FE AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-4136
Country	:	US
Telephone Number	:	719-676-2100
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JENNI CORINNE DRAKE
Credential	:	OD
Telephone Number	:	215-870-4624

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	01/19/2026

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