Provider Demographics
NPI:1487103339
Name:COLORADO CENTER FOR VISUAL PERFORMANCE LLC
Entity type:Organization
Organization Name:COLORADO CENTER FOR VISUAL PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-828-9877
Mailing Address - Street 1:71 ERIE PKWY UNIT 105
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2520
Mailing Address - Country:US
Mailing Address - Phone:303-828-9877
Mailing Address - Fax:303-828-9878
Practice Address - Street 1:71 ERIE PKWY UNIT 105
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2520
Practice Address - Country:US
Practice Address - Phone:303-828-9877
Practice Address - Fax:303-828-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT2732152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty