Organization Active NPI

Vital Vision PLLC

  • Optometrist
  • Bozeman, MT
National Provider Identifier
1962024125
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
VITAL VISION PLLC
Practice address
270 W Kagy Blvd Ste B
Bozeman, MT 59715-6055
Phone
(406) 404-1666
Fax
(406) 404-1885
NPI assigned
May 11, 2020
Last updated
May 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
Eude A Ossorio, CONSULTANT
Title
Consultant
Phone
(662) 510-2941

Specialties & licenses 1

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

Addresses

Primary practice location

270 W Kagy Blvd Ste B
Bozeman, MT 59715-6055

Mailing address

270 W Kagy Blvd Ste B
Bozeman, MT 59715-6055
Phone (406) 404-1666

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200616001668 MT Part B Supplier - Clinic/Group Practice 0941622112 Receives reassigned benefits from 3 practitioners
Practice locations: Bozeman, MT

National Provider Directory

National Provider Directory

Locations

270 W Kagy Blvd
Ste B
Bozeman, MT 59715
Phone (406) 404-1375

Practitioners & affiliated clinicians

Practitioners 3

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": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1962024125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 W KAGY BLVD STE B",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156055",
            "telephone_number": "406-404-1666",
            "fax_number": "406-404-1885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 W KAGY BLVD STE B",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156055",
            "telephone_number": "406-404-1666",
            "fax_number": "406-404-1885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL VISION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "OSSORIO",
        "authorized_official_first_name": "EUDE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "662-510-2941",
        "authorized_official_credential": "CONSULTANT"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bozeman, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.