Evergreen Vision Clinic, PC
Organization Active NPI Eyewear Supplier · Evergreen, CO
NPI 1487741542 · NPPES record last updated Nov 2, 2007
Key facts
- NPI
- 1487741542
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- License
- 1747 (CO)
- Legal business name
- EVERGREEN VISION CLINIC, PC
- Practice address
- 30960 Stagecoach Blvd # W200
Evergreen, CO 80439-7902 - Phone
- (303) 674-4143
- Fax
- (303) 670-4081
- NPI assigned
- Oct 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Daniel R. Hock, O.D.
- Title
- Optometrist
- Phone
- (303) 674-4143
Practitioners 4
-
Daniel R. Hock, O.D.
-
Donald Paul Kaiser, O.D.
-
Sarah Sandhaus, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040330000380 | CO | Part B Supplier - Clinic/Group Practice | 0244122539 |
Receives reassigned benefits from 2 practitioners Practice locations: Evergreen, CO |
National Provider Directory
Locations
30960 Stagecoach Blvd
Ste 200
Evergreen, CO 80439
30960 Stagecoach Blvd
Ste 200210
Evergreen, CO 80439
30960 Stagecoach Blvd
#200
Evergreen, CO 80439
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | 1747 | CO | Yes |
Addresses
Primary practice location
30960 Stagecoach Blvd # W200
Evergreen, CO 80439-7902
Mailing address
30960 Stagecoach Blvd # W200
Evergreen, CO 80439-7902
Other providers in Evergreen, CO
- Evergreen Pediatrics, LLC
- Evergreen Physical Therapy Specialists, PC
- Evergreen Psychotherapy Center
- Evergreen Spine and Sports Medicine LLC
- Evergreen Therapeutic Massage LLC
- Fabled Counseling
- Jennifer Faike
- Christine Marrie Fale
- Caryl Fank
- Kathleen Farrell
All providers in Evergreen, CO · Eyewear Supplier in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.