Organization Active NPI

Envision Boulder

  • Optometrist
  • Boulder, CO
National Provider Identifier
1982873543
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ENVISION BOULDER
Practice address
1011 Pearl St
Boulder, CO 80302-5110
Phone
(303) 939-8021
NPI assigned
Feb 27, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Authorized official

Name
Mrs. Nancy M Wells
Title
Assistant
Phone
(303) 939-8021

Specialties & licenses 1

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

Addresses

Primary practice location

1011 Pearl St
Boulder, CO 80302-5110

Mailing address

1011 Pearl St
Boulder, CO 80302-5110
Phone (303) 939-8021

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316000883 CO Part B Supplier - Clinic/Group Practice 1153211073 Receives reassigned benefits from 3 practitioners
Practice locations: Boulder, CO

National Provider Directory

National Provider Directory

Locations

1011 Pearl St
Boulder, CO 80302
Phone (303) 939-8021

1230 Spruce St
Boulder, CO 80302
Phone (303) 939-8021

Practitioners & affiliated clinicians

Practitioners 4

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": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1982873543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 PEARL ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803025110",
            "telephone_number": "303-939-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 PEARL ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803025110",
            "telephone_number": "303-939-8021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION BOULDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-27",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ASSISTANT",
        "authorized_official_telephone_number": "303-939-8021",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.