Eastlake Vision Clinic PC

NPI #1801071709 in Thornton, Colorado

Provider Information

NPI Number: 1801071709
Entity Type: Organization
Organization Name: Eastlake Vision Clinic PC
Primary Specialty: Optometrist
Enumeration Date: Jan 9, 2008
Last Updated: Feb 5, 2008

Practice Location

Address: 12450 YORK ST
City: Thornton
State: Colorado
ZIP Code: 80241-2741
Phone: (303) 452-2020

Authorized Official

Name: DR. STANLEY R BLACK, O.D.
Title: PRESIDENT
Phone: (303) 452-2020

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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