| Organization Name: | CLASSIQUE VISION, LLC |
| NPI Number: | 1003167941 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BABY JANE FAYTAREN (CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 12208 Chimney Smoke Dr Peyton |
| State: | CO US |
| Postal Code: | 808318484 |
| Phone Number: | 7196237876 |
| Fax Number: | 7194450130 |
| NPI Enumeration Date: | 10/01/2012 |
| NPI Last Update Date: | 10/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 150964 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |