MEDICARE: PARKRIDGE VISION SPECIALISTS, PC

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	2040	CO
2	152WC0802X	Corneal and Contact Management Optometrist	2038	CO
3	152WC0802X	Corneal and Contact Management Optometrist	2040	CO
4	152WP0200X	Pediatric Optometrist	2038	CO
5	152WP0200X	Pediatric Optometrist	2040	CO
6	152WS0006X	Sports Vision Optometrist	2038	CO
7	152W00000X	Optometrist	2038	CO

General Provider Information

NPI Number	:	1326268921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKRIDGE VISION SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	9400 STATION ST
Second Line	:	SUITE 150
City	:	LONETREE
State	:	CO
Zip	:	80124-6808
Country	:	US
Telephone Number	:	303-925-0075
Fax Number	:	303-925-0079

Provider Business Practice Location Address
First Line	:	9400 STATION ST
Second Line	:	SUITE 150
City	:	LONETREE
State	:	CO
Zip	:	80124-6808
Country	:	US
Telephone Number	:	303-925-0075
Fax Number	:	303-925-0079

Authorized Official
Title or Position	:	VICE PRES
Name	:	DR. MICHELLE SANCHO
Credential	:	OD
Telephone Number	:	303-925-0075

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	09/17/2014

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