NPIMap

Organization Active NPI

Madison Street Provider Network Inc

Doing business as Spivack Vision Center

  • Ophthalmology Physician
  • Centennial, CO
National Provider Identifier
1063019214
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MADISON STREET PROVIDER NETWORK INC
Doing business as
Spivack Vision Center
Practice address
6881 S Yosemite St
Centennial, CO 80112-1406
Phone
(303) 733-2020
Fax
(303) 377-2022
NPI assigned
Oct 1, 2020
Last updated
Oct 1, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MADISON STREET PROVIDER NETWORK INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
George L Neal
Title
President
Phone
(469) 214-0144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

6881 S Yosemite St
Centennial, CO 80112-1406

Mailing address

PO Box 912914
Denver, CO 80291-2914

Other names 1

  • Spivack Vision Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Madison Street Provider Network Inc10 organizations share this tax ID, including this one
Part of
Madison Street Provider Network Inc

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1063019214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 912914",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802912914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6881 S YOSEMITE ST",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801121406",
            "telephone_number": "303-733-2020",
            "fax_number": "303-377-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON STREET PROVIDER NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MADISON STREET PROVIDER NETWORK INC",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-214-0144"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spivack Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centennial, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.