Organization
MADISON STREET PROVIDER NETWORK INC
Active
Parent organization
MADISON STREET PROVIDER NETWORK INC
Other names
Spivack Vision Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MADISON STREET PROVIDER NETWORK INC
Authorized official
GEORGE L NEAL (PRESIDENT)
(469) 214-0144
Entity
Organization
Contact information
Practice address
6881 S YOSEMITE ST, CENTENNIAL, CO 80112-1406
(303) 733-2020
(303) 377-2022
Mailing address
PO BOX 912914, DENVER, CO 80291-2914
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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