NPIMap

Organization Active NPI

Table Mountain Vision Center 2020, LLC

  • Optometrist
  • Golden, CO
National Provider Identifier
1346886587
Registry record updated Apr 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TABLE MOUNTAIN VISION CENTER 2020, LLC
Practice address
1409 Washington Ave
Golden, CO 80401-1917
Phone
(303) 271-1400
NPI assigned
Nov 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2020

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

Authorized official

Name
Dr. Elizabeth Anne Peterson, ODNPI 1730274234
Title
Optometrist
Phone
(303) 271-1400

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

1409 Washington Ave
Golden, CO 80401-1917

Mailing address

1409 Washington Ave
Golden, CO 80401-1917
Phone (303) 271-1400

Other names 1

  • Table Mountain Vision Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200429001008 CO Part B Supplier - Clinic/Group Practice 2163852435 Receives reassigned benefits from 3 practitioners
Practice locations: Golden, CO

National Provider Directory

National Provider Directory

Locations

1409 Washington Ave
Golden, CO 80401
Phone (303) 271-1400

Practitioners & affiliated clinicians

Practitioners 5

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": "1574380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1346886587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 WASHINGTON AVE",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804011917",
            "telephone_number": "303-271-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 WASHINGTON AVE",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804011917",
            "telephone_number": "303-271-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABLE MOUNTAIN VISION CENTER 2020, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-22",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "303-271-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Table Mountain Vision",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Table Mountain Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Golden, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; 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.