NPIMap

Organization Active NPI

Total Vision Eye Care Group, LLC

Doing business as ICON EyeCare

  • Ophthalmology Physician
  • Englewood, CO
National Provider Identifier
1639772494
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
TOTAL VISION EYE CARE GROUP, LLC
Doing business as
ICON EyeCare
Practice address
10520 El Diente CT Ste a
Englewood, CO 80112-2656
Phone
(720) 524-1001
Fax
(720) 524-1121
NPI assigned
Nov 16, 2020
Last updated
Nov 16, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
TOTAL VISION EYE CARE GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Authorized official

Name
Christian Ellison
Title
Ceo
Phone
(720) 524-1001

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

10520 El Diente CT Ste a
Englewood, CO 80112-2656

Mailing address

3900 E Mexico Ave Ste 102
Denver, CO 80210-3941
Phone (720) 524-1001

Other names 1

  • ICON EyeCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205001077 CO Part B Supplier - Clinic/Group Practice 2163315854 Receives reassigned benefits from 28 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Denver, CO; Westminster, CO; Grand Junction, CO; Golden, CO; Fort Collins, CO; Englewood, CO; Basalt, CO; Aurora, CO

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Total Vision Eyecare10 organizations share this tax ID, including this one
Part of
Total Vision Eyecare

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1639772494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 E MEXICO AVE STE 102",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802103941",
            "telephone_number": "720-524-1001",
            "fax_number": "720-524-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10520 EL DIENTE CT STE A",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801122656",
            "telephone_number": "720-524-1001",
            "fax_number": "720-524-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL VISION EYE CARE GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TOTAL VISION EYE CARE GROUP, LLC",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "720-524-1001"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICON EyeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Englewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.