Organization
PINE CREEK VISION CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS A WILSON O.D. (OPTOMETRIST/OWNER)
(719) 651-4014
Entity
Organization
Contact information
Practice address
9475-A BRIAR VILLAGE PT, SUITE 200, COLORADO SPRINGS, CO 80920-7902
(719) 594-2020
(719) 694-8562
Mailing address
9475-A BRIAR VILLAGE PT, SUITE 200, COLORADO SPRINGS, CO 80920-7902
(719) 594-2020
(719) 694-8562
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1380
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DU0051
RAILROAD MEDICARE PTAN
CO
Enumeration date
12/08/2011
Last updated
10/23/2013
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