1073648424 NPI number — SVS VISION INC

Table of content: (NPI 1073648424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073648424 NPI number — SVS VISION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SVS VISION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SVS VISION 38
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073648424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 CASS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT CLEMENS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48043-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-464-1479
Provider Business Mailing Address Fax Number:
586-464-1480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3552 HIGHWAY 138 SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-4170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-506-7310
Provider Business Practice Location Address Fax Number:
770-506-7598
Provider Enumeration Date:
02/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FARRELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
586-468-7370

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)