NPIMap

Organization Active NPI

Eastlake Vision Clinic PC

  • Optometrist
  • Thornton, CO
National Provider Identifier
1801071709
Registry record updated Feb 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
830 Issued in CO
Legal business name
EASTLAKE VISION CLINIC PC
Practice address
12450 York St
Thornton, CO 80241-2741
Phone
(303) 452-2020
Fax
(303) 452-0934
NPI assigned
Jan 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2008

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

Authorized official

Name
Dr. Stanley R Black, O.D.
Title
President
Phone
(303) 452-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 830 CO Primary

Addresses

Primary practice location

12450 York St
Thornton, CO 80241-2741

Mailing address

12450 York St
Thornton, CO 80241-2741
Phone (303) 452-2020

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1801071709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12450 YORK ST",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802412741",
            "telephone_number": "303-452-2020",
            "fax_number": "303-452-0934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 YORK ST",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802412741",
            "telephone_number": "303-452-2020",
            "fax_number": "303-452-0934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAKE VISION CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-452-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; 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.