| Vision Source Longmont, Pc | |
|
2130 Mountain View Avenue, Suite 207, Longmont, CO 80501 | |
| (303) 772-2755 | |
| Not Available |
| Full Name | Vision Source Longmont, Pc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 2130 Mountain View Avenue, Longmont, Colorado |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104980234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 857 (Colorado) | Primary |
| Provider Name | Jason L Kaminski |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1790788156 PECOS PAC ID: 2769373000 Enrollment ID: I20100809000695 |
| Provider Name | Yessica G Canas |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1447829916 PECOS PAC ID: 7517368368 Enrollment ID: I20210630001928 |
| Provider Name | Veda Janel Magagna |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1336870393 PECOS PAC ID: 2769864453 Enrollment ID: I20220727002616 |
| Mailing Address | Practice Location Address |
|---|---|
| Vision Source Longmont, Pc 2130 Mountain View Avenue, Suite 207, Longmont, CO 80501 Ph: () - | Vision Source Longmont, Pc 2130 Mountain View Avenue, Suite 207, Longmont, CO 80501 Ph: (303) 772-2755 |
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