Organization
HTI3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI EDWARDS (MBR)
(970) 581-4586
Entity
Organization
Contact information
Practice address
2120 VILLAGE VISTA DR UNIT 130, ERIE, CO 80516-7073
(970) 581-4586
Mailing address
180 KEN PRATT BLVD STE 200, LONGMONT, CO 80501-8974
(970) 581-4586
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
09/01/2023
Last updated
09/01/2023
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