1447406681 NPI number — VISION SPECIALTY SERVICES LLC

Table of content: (NPI 1447406681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447406681 NPI number — VISION SPECIALTY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION SPECIALTY SERVICES LLC
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:
ANNAPOLIS OPTICAL
Provider Other Organization Name Type Code:
3
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:
1447406681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13310 WICKLOW PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21029-1439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-854-0864
Provider Business Mailing Address Fax Number:
410-531-6815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2331 FOREST DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-224-8908
Provider Business Practice Location Address Fax Number:
410-224-0871
Provider Enumeration Date:
08/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
M.
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-906-5039

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA0900 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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