Loveland Vision Prof Co LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2850 Issued in CO

Legal business name

LOVELAND VISION PROF CO LLC

Practice address

1325 Denver Ave
Loveland, CO 80537-5120

Phone

(970) 663-3937

Fax

(970) 669-7518

NPI assigned

Dec 27, 2011

Organization subpart

No

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

Authorized official

Name

Michael Edward Koditek

Title

Owner

Phone

(970) 663-3937

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338422400000",
    "number": "1982973624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 DENVER AVE",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805375120",
            "telephone_number": "970-663-3937",
            "fax_number": "970-669-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 DENVER AVE",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805375120",
            "telephone_number": "970-663-3937",
            "fax_number": "970-669-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOVELAND VISION PROF CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-27",
        "last_updated": "2012-05-31",
        "status": "A",
        "authorized_official_last_name": "KODITEK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-663-3937"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Loving Light Psychotherapy Center, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.