Provider Demographics
NPI:1871755041
Name:BAYFIELD FAMILY EYE CARE LLC
Entity type:Organization
Organization Name:BAYFIELD FAMILY EYE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-884-6188
Mailing Address - Street 1:480 WOLVERINE DR
Mailing Address - Street 2:# 5
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9653
Mailing Address - Country:US
Mailing Address - Phone:970-884-6188
Mailing Address - Fax:970-884-2869
Practice Address - Street 1:480 WOLVERINE DR
Practice Address - Street 2:# 5
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-9653
Practice Address - Country:US
Practice Address - Phone:970-884-6188
Practice Address - Fax:970-884-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2532OtherCOPLORADO OPTOMETRIC LICENSE #
CO267474590OtherPERSONAL SS# FOR JONATHAN E ZISSMAN
CO1396770962OtherPERSONAL NPI
CO1396770962OtherPERSONAL NPI
CO1396770962OtherPERSONAL NPI