Provider Demographics
NPI:1053621367
Name:VIRGINIA VISION CARE ASSOC., L.L.C.
Entity type:Organization
Organization Name:VIRGINIA VISION CARE ASSOC., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EWING
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-767-1907
Mailing Address - Street 1:203 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-1707
Mailing Address - Country:US
Mailing Address - Phone:720-767-1907
Mailing Address - Fax:303-366-1733
Practice Address - Street 1:365 N TELLURIDE ST
Practice Address - Street 2:
Practice Address - City:BUCKLEY AFB
Practice Address - State:CO
Practice Address - Zip Code:80011-7809
Practice Address - Country:US
Practice Address - Phone:720-767-1907
Practice Address - Fax:303-366-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty