Cortez Vision PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2046 Issued in CO

Legal business name

CORTEZ VISION PC

Practice address

2423 E Main St Ste 4
Cortez, CO 81321-4269

Phone

(970) 565-2020

Fax

(970) 565-3632

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Bryce TannerNPI 1609181148

Title

Owner

Phone

(970) 565-2020

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Cortez Vision Clinic Former legal business name

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryce Tanner, OD

  • Optometrist
  • Cortez, CO
  • NPI 1609181148
  Medicare reassignment NPD Authorized official
• William Howard Mollenkopf, OD

  • Optometrist
  • Cortez, CO
  • NPI 1235294836
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1992868194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813210820",
            "telephone_number": "970-565-2020",
            "fax_number": "970-565-3632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2423 E MAIN ST STE 4",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813214269",
            "telephone_number": "970-565-2020",
            "fax_number": "970-565-3632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORTEZ VISION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "BRYCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-565-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2046",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "904",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2803",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06979238",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cortez Vision Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Cortez Dental
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• Cortez Medical Clinic Inc
• Cortez Orthodontics
• Cortez Smiles, PC
• Grace Marie Costello, LCSW
• Carol Cover, LPC
• Hubert Lee Cox
• Tonja L Cox, BSN
• Elizabeth Claire Cripps, NP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.