Lake Dillon Eye Care, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

43711 Issued in CO

Legal business name

LAKE DILLON EYE CARE, LLC

Doing business as

Lake Dillon Eye Care

Practice address

325 Lake Dillon Dr Ste 104
Dillon, CO 80435-5509

Phone

(970) 468-0389

Fax

(970) 468-4790

NPI assigned

Jan 12, 2012

Last updated

Oct 13, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amanda Rush Patton

Title

Manager

Phone

(970) 468-0389

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Dillon Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

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.

• Wills Vanray, OD

  • Optometrist
  • Dillon, CO
  • NPI 1508940065
  Medicare reassignment
• Debra Ann Meese, O.D., PH.D.

  • Optometrist
  • Eagle, CO
  • NPI 1508820457
  NPD (past)

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1801166475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2804",
            "city": "DILLON",
            "state": "CO",
            "postal_code": "804352804",
            "telephone_number": "970-468-0389",
            "fax_number": "970-468-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 LAKE DILLON DR STE 104",
            "city": "DILLON",
            "state": "CO",
            "postal_code": "804355509",
            "telephone_number": "970-468-0389",
            "fax_number": "970-468-4790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE DILLON EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-12",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "PATTON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "RUSH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "970-468-0389"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "43711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000193505",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Dillon Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Kaminsky, DMD
• Kintz Consulting LLC
• Carly Klohs
• Brandon Roy Kondo, PHARMD
• Allen Kvidera, D.D.S.
• Marissa J Lampe, LSW
• Auburn Larue
• Samuel Lipfield
• Melissa Hope Malter, LSW
• Corry Lynn Marcincin, DMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; 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.