MEDICARE: STEAMBOAT VISION CLINIC, P.C.

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	1607	CO

General Provider Information

NPI Number	:	1316124225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEAMBOAT VISION CLINIC, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 773007
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-3007
Country	:	US
Telephone Number	:	970-879-4266
Fax Number	:	970-879-7692

Provider Business Practice Location Address
First Line	:	130 NINTH ST.
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487
Country	:	US
Telephone Number	:	970-879-4266
Fax Number	:	970-879-7692

Authorized Official
Title or Position	:	PRESIDENT / OPTOMETRIST
Name	:	DR. GARY MIGUES
Credential	:	O.D.
Telephone Number	:	970-879-4266

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/23/2008

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