Provider Demographics
NPI:1316109481
Name:TOTAL VISION EYE CARE GROUP LLC
Entity type:Organization
Organization Name:TOTAL VISION EYE CARE GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-273-7449
Mailing Address - Street 1:3900 E MEXICO AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3940
Mailing Address - Country:US
Mailing Address - Phone:720-524-1001
Mailing Address - Fax:720-524-1121
Practice Address - Street 1:3900 E MEXICO AVE STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3941
Practice Address - Country:US
Practice Address - Phone:720-524-1001
Practice Address - Fax:720-524-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020053Medicaid
COCH0866OtherRAILROAD MEDICARE
COE61455Medicare UPIN
COT60864Medicare UPIN
CO447928Medicare UPIN
CO04020053Medicaid