Provider Demographics
NPI:1306991096
Name:VOSSETEIG, GREGORY A
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:VOSSETEIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 S SHIELDS ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2583
Mailing Address - Country:US
Mailing Address - Phone:970-490-2020
Mailing Address - Fax:970-221-3121
Practice Address - Street 1:3501 S. SHIELDS ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2583
Practice Address - Country:US
Practice Address - Phone:970-490-2020
Practice Address - Fax:970-221-3121
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08016131Medicaid
COP00273245OtherRR MEDICARE
CO08016131Medicaid
COC43483Medicare PIN
CO841453399OtherTAX ID NUMBER
COU45472Medicare UPIN