Provider Demographics
NPI:1982472213
Name:TANNER VISION SERVICES PLLC
Entity type:Organization
Organization Name:TANNER VISION SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-746-9401
Mailing Address - Street 1:101 SUNDIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-7769
Mailing Address - Country:US
Mailing Address - Phone:719-687-3937
Mailing Address - Fax:719-687-9308
Practice Address - Street 1:101 SUNDIAL DR STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-7769
Practice Address - Country:US
Practice Address - Phone:719-687-3937
Practice Address - Fax:719-687-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty