NPIMap

Organization Active NPI

Visionary Eye Care, PLLC

  • Optometrist
  • Broomfield, CO
National Provider Identifier
1205482031
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
VISIONARY EYE CARE, PLLC
Doing business as
Visionary Eye Care
Practice address
16860 Sheridan Pkwy Unit 106
Broomfield, CO 80023-8989
Phone
(720) 598-2020
Fax
(720) 893-9070
NPI assigned
Aug 16, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Authorized official

Name
Tiffany Gates, OD, FAAO, FSLSNPI 1922412915
Title
Optometrist
Phone
(714) 932-4766

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

16860 Sheridan Pkwy Unit 106
Broomfield, CO 80023-8989

Mailing address

16860 Sheridan Pkwy Unit 106
Broomfield, CO 80023-8989
Phone (720) 598-2020

Other names 1

  • Visionary Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191003003100 CO Part B Supplier - Clinic/Group Practice 9032440169 Receives reassigned benefits from 3 practitioners
Practice locations: Broomfield, CO

National Provider Directory

National Provider Directory

Locations

16860 Sheridan Pkwy
Unit 106
Broomfield, CO 80023
Phone (720) 598-2020

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1205482031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16860 SHERIDAN PKWY UNIT 106",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800238989",
            "telephone_number": "720-598-2020",
            "fax_number": "720-893-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16860 SHERIDAN PKWY UNIT 106",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800238989",
            "telephone_number": "720-598-2020",
            "fax_number": "720-893-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISIONARY EYE CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-16",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "GATES",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "714-932-4766",
        "authorized_official_credential": "OD, FAAO, FSLS"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Visionary Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Visionary Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broomfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.