NPIMap

Organization Active NPI

Park West Vision, LLC

Doing business as Park West Dental & Vision

  • Optometrist
  • Pueblo, CO
National Provider Identifier
1093233348
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PARK WEST VISION, LLC
Doing business as
Park West Dental & Vision
Park West Vision
Practice address
3470 Parker Blvd
Pueblo, CO 81008
Phone
(719) 553-7149
Fax
(719) 266-6163
NPI assigned
Sep 7, 2017
Last updated
Jul 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Authorized official

Name
Joe Lee
Title
Partner
Phone
(719) 289-2113

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT0002851 CO
Optometrist 152W00000X Primary

Addresses

Primary practice location

3470 Parker Blvd
Pueblo, CO 81008

Mailing address

3470 Parker Blvd Ste B
Pueblo, CO 81008-2280
Phone (719) 289-2113

Other identifiers 2

IdentifierTypeStateIssuer
1629303284OtherISSUED BY PACIFIC UNIVERSITY DURING OPTOMETRY SCHOOL
1093233348OtherCOISSUED BY NPI GOVERNING BODY

Other names 2

  • Park West Dental & Vision Doing business as
  • Park West Vision Doing business as

National Provider Directory

National Provider Directory

Locations

3470 Parker Blvd
Ste B
Pueblo, CO 81008

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531785600000",
    "number": "1093233348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3470 PARKER BLVD STE B",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082280",
            "telephone_number": "719-289-2113",
            "fax_number": "719-266-6163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3470 PARKER BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "81008",
            "telephone_number": "719-553-7149",
            "fax_number": "719-266-6163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK WEST VISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-07",
        "last_updated": "2018-07-17",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "719-289-2113"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT0002851",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ISSUED BY PACIFIC UNIVERSITY DURING OPTOMETRY SCHOOL",
            "identifier": "1629303284",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ISSUED BY NPI GOVERNING BODY",
            "identifier": "1093233348",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park West Dental & Vision",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Park West Vision",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Park West Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; 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.