1649408774 NPI number — RM VISION PC

Table of content: (NPI 1649408774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649408774 NPI number — RM VISION PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RM VISION PC
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:
Provider Other Organization Name Type Code:
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:
1649408774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 EVENSVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENCASTLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46135-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-653-8245
Provider Business Mailing Address Fax Number:
765-653-5009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2399 S STATE ROAD 46
Provider Second Line Business Practice Location Address:
WAL-MART VISION CENTER
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47803-9306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-872-2537
Provider Business Practice Location Address Fax Number:
812-872-2539
Provider Enumeration Date:
06/26/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
765-653-8245

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18003118A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 18001975A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 18003118A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 18001975A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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