Main Street Vision Care, Co.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1188 Issued in CO

Legal business name

MAIN STREET VISION CARE, CO.

Practice address

412 Main St
Longmont, CO 80501-5535

Phone

(303) 651-6700

NPI assigned

Feb 15, 2018

Organization subpart

No

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

Authorized official

Name

Roger Trudell, OD

Title

Owner

Phone

(303) 651-6700

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518652800000",
    "number": "1740780840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 MAIN ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015535",
            "telephone_number": "303-651-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 MAIN ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015535",
            "telephone_number": "303-651-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET VISION CARE, CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-15",
        "last_updated": "2018-02-15",
        "status": "A",
        "authorized_official_last_name": "TRUDELL",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-651-6700",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "1188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Mahannah
• Marilyn Haas Maher, PH.D.
• Scott Mahlberg, DO
• Michael Davis Mahoney, LPCC
• Main Street Family Denistry
• Jason Donald Main, DPT
• Lydi An Maine-Pope, L.C.S.W.
• Mainspring Well Center
• Rachel Majors
• Malcolm J. Monlezun, LLC

• Optometrist in Longmont, CO
• Providers in Longmont, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; 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.