NPIMap

Organization Active NPI

Foothills Vision Center, PC

  • Optometrist
  • Lakewood, CO
National Provider Identifier
1790996379
Registry record updated Dec 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2107 Issued in CO
Legal business name
FOOTHILLS VISION CENTER, PC
Practice address
12810 W Alameda Pkwy
Suite B
Lakewood, CO 80228-3116
Phone
(303) 986-5565
Fax
(303) 984-2111
NPI assigned
May 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2015

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

Authorized official

Name
Dr. Kevin J Krajewski, ODNPI 1114948247
Title
President
Phone
(303) 986-5565

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 MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 2107 CO Primary

Addresses

Primary practice location

12810 W Alameda Pkwy
Suite B
Lakewood, CO 80228-3116

Mailing address

12810 W Alameda Pkwy
Suite B
Lakewood, CO 80228-3116
Phone (303) 986-5565

Other names 1

  • Foothills Vision Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406000456 CO Part B Supplier - Clinic/Group Practice 9234122219 Receives reassigned benefits from 3 practitioners
Practice locations: Lakewood, CO

National Provider Directory

National Provider Directory

Locations

12810 W Alameda Pkwy
Unit B
Lakewood, CO 80228
Phone (303) 986-5565

Practitioners & affiliated clinicians

Practitioners 3

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": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1790996379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12810 W ALAMEDA PKWY",
            "address_2": "SUITE B",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802283116",
            "telephone_number": "303-986-5565",
            "fax_number": "303-984-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12810 W ALAMEDA PKWY",
            "address_2": "SUITE B",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802283116",
            "telephone_number": "303-986-5565",
            "fax_number": "303-984-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS VISION CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "KRAJEWSKI",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-986-5565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foothills Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.