Provider Demographics
NPI:1053356543
Name:PRECISION FAMILY EYECARE PC
Entity type:Organization
Organization Name:PRECISION FAMILY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHANEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-587-0827
Mailing Address - Street 1:257 JOHNSTOWN CENTER DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9073
Mailing Address - Country:US
Mailing Address - Phone:970-587-0827
Mailing Address - Fax:
Practice Address - Street 1:257 JOHNSTOWN CENTER DR
Practice Address - Street 2:SUITE 107
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9073
Practice Address - Country:US
Practice Address - Phone:970-587-0827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2410152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6039460001Medicare NSC
CO805602Medicare PIN
COU96339Medicare UPIN