MEDICARE: TOTAL VISION EYE CARE GROUP LLC

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1689528416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL VISION EYE CARE GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 200426
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-0426
Country	:	US
Telephone Number	:	720-524-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	4103 BOARDWALK DR UNIT 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5933
Country	:	US
Telephone Number	:	303-377-2020
Fax Number	:	303-377-2022

Authorized Official
Title or Position	:	CFO
Name	:	JEFF ABBATE
Credential	:
Telephone Number	:	720-524-1001

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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