1962600825 NPI number — OMNI VISIONS, INC.

Table of content: (NPI 1962600825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962600825 NPI number — OMNI VISIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNI VISIONS, 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:
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:
1962600825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 S PERIMETER PARK DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37211-4143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-726-3603
Provider Business Mailing Address Fax Number:
615-726-3632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 C ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
N WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28659-4145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-838-2412
Provider Business Practice Location Address Fax Number:
336-667-5773
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WADDELL
Authorized Official First Name:
BRELYN
Authorized Official Middle Name:
Authorized Official Title or Position:
AR MANAGER
Authorized Official Telephone Number:
919-334-0249

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  NA , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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