1356523468 NPI number — ST. CROIX VISION CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356523468 NPI number — ST. CROIX VISION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CROIX VISION CENTER
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:
6
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:
1356523468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5996
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANSTED
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00823-5996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-773-2020
Provider Business Mailing Address Fax Number:
340-778-0977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 NISKY CENTER
Provider Second Line Business Practice Location Address:
SUITE #19 NISKY CENTER
Provider Business Practice Location Address City Name:
ST. THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-776-2020
Provider Business Practice Location Address Fax Number:
340-778-0977
Provider Enumeration Date:
11/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MASCHAUER
Authorized Official First Name:
CARL
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
340-773-2020

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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