NPIMap

Organization Active NPI

Tanner Vision Services PLLC

Doing business as Woodland Vision Source

  • Optometrist
  • Woodland Park, CO
National Provider Identifier
1982472213
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TANNER VISION SERVICES PLLC
Doing business as
Woodland Vision Source
Practice address
101 Sundial Dr Ste C
Woodland Park, CO 80863-7769
Phone
(719) 687-3937
Fax
(719) 687-9308
NPI assigned
Dec 15, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Authorized official

Name
Bruce TannerNPI 1508437906
Title
Owner
Phone
(801) 746-9401

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 SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

101 Sundial Dr Ste C
Woodland Park, CO 80863-7769

Mailing address

101 Sundial Dr Ste C
Woodland Park, CO 80863-7769
Phone (719) 687-3937

Other names 1

  • WOODLAND VISION SOURCE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240613000967 CO Part B Supplier - Clinic/Group Practice 8527500917 Receives reassigned benefits from 2 practitioners
Practice locations: Woodland Park, CO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1702598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1982472213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUNDIAL DR STE C",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808637769",
            "telephone_number": "719-687-3937",
            "fax_number": "719-687-9308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SUNDIAL DR STE C",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808637769",
            "telephone_number": "719-687-3937",
            "fax_number": "719-687-9308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANNER VISION SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-15",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-746-9401"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WOODLAND VISION SOURCE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WOODLAND VISION SOURCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodland Park, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.