Organization
BALLANTYNE VISION CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN BALLANTYNE O.D. (OPTOMETRIST, OWNER)
(719) 383-0134
Entity
Organization
Contact information
Practice address
302 W 3RD ST, LA JUNTA, CO 81050-1430
(719) 383-0134
(719) 404-1825
Mailing address
PO BOX 305, LA JUNTA, CO 81050-0305
(719) 383-0134
(719) 404-1825
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2799
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306146121
NPI FOR LAMAR OFFICE
CO
05
—
93920288
—
CO
01
—
COA106109
MEDICARE GROUP PTAN
CO
Enumeration date
10/26/2010
Last updated
10/10/2016
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