NPIMap

Organization Active NPI

Northwest Eyecare Center, LLC

  • Optometrist
  • Craig, CO
National Provider Identifier
1275523938
Registry record updated Sep 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
848 Issued in CO
Legal business name
NORTHWEST EYECARE CENTER, LLC
Practice address
1111 W Victory Way
Suite 110
Craig, CO 81625-2950
Phone
(970) 824-3488
Fax
(970) 824-8132
NPI assigned
Oct 25, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2008

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

Authorized official

Name
Dr. Ronald J. Danner, O.D.
Title
Owner / Manager
Phone
(970) 824-3488

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 848 CO Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 1589 CO

Addresses

Primary practice location

1111 W Victory Way
Suite 110
Craig, CO 81625-2950

Mailing address

1111 W Victory Way
Suite 110
Craig, CO 81625-2950
Phone (970) 824-3488

Other identifiers 2

IdentifierTypeStateIssuer
04018867MedicaidCO
1471066OtherCOUMWA

Other names 1

  • Eyecare Specialties Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220572800000",
    "number": "1275523938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W VICTORY WAY",
            "address_2": "SUITE 110",
            "city": "CRAIG",
            "state": "CO",
            "postal_code": "816252950",
            "telephone_number": "970-824-3488",
            "fax_number": "970-824-8132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W VICTORY WAY",
            "address_2": "SUITE 110",
            "city": "CRAIG",
            "state": "CO",
            "postal_code": "816252950",
            "telephone_number": "970-824-3488",
            "fax_number": "970-824-8132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST EYECARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-25",
        "last_updated": "2008-09-05",
        "status": "A",
        "authorized_official_last_name": "DANNER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER / MANAGER",
        "authorized_official_telephone_number": "970-824-3488",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "848",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "1589",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04018867",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1471066",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Craig, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2008; 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.