1710918974 NPI number — CONSOLIDATED VISION GROUP

Table of content: (NPI 1710918974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710918974 NPI number — CONSOLIDATED VISION GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSOLIDATED VISION GROUP
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:
AMERICA'S BEST CONTACTS AND EYEGLASSES
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:
1710918974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
296 GRAYSON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-5737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-822-3600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 NORTHSHORE BLVD # 131
Provider Second Line Business Practice Location Address:
VILLAGE OF NORTH SHORE
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70460-6821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-643-6666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EDICK
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MC ASSISTANT
Authorized Official Telephone Number:
678-892-3774

Provider Taxonomy Codes

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

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