Blue River Vision PLLC
Organization Active NPI Optometrist · Silverthorne, CO
NPI 1609387703 · NPPES record last updated Jan 12, 2018
Key facts
- NPI
- 1609387703
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2671 (CO)
- Legal business name
- BLUE RIVER VISION PLLC
- Practice address
- 358 Blue River Pkwy
Suite D
Silverthorne, CO 80498 - Phone
- (303) 503-6397
- NPI assigned
- Oct 16, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Jessica J Hegewald, OD
- Title
- Optometrist / Owner
- Phone
- (970) 368-6539
Practitioners 2
-
Megan Schmauder, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180410000737 | CO | Part B Supplier - Clinic/Group Practice | 1153684998 |
Receives reassigned benefits from 2 practitioners Practice locations: Silverthorne, CO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2671 | CO | Yes |
| Sports Vision Optometrist |
152WS0006X | 2671 | CO | |
| Vision Therapy Optometrist |
152WV0400X | 2671 | CO |
Addresses
Primary practice location
358 Blue River Pkwy
Suite D
Silverthorne, CO 80498
Mailing address
P.O. Box 402
PMB 310
Dillon, CO 80435-0402
Phone (970) 368-6539
Other providers in Silverthorne, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2018. 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.