1861738965 NPI number — CLEARER VISION INC

Table of content: (NPI 1861738965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861738965 NPI number — CLEARER VISION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEARER VISION 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:
1861738965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 74484
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROMULUS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48174-0484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-738-4986
Provider Business Mailing Address Fax Number:
248-738-5682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40055 CAMBRIDGE
Provider Second Line Business Practice Location Address:
STE #104
Provider Business Practice Location Address City Name:
ROMULUS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48174-3846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-738-4986
Provider Business Practice Location Address Fax Number:
248-738-5682
Provider Enumeration Date:
12/17/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARGRESS
Authorized Official First Name:
NED
Authorized Official Middle Name:
FORREST
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-738-4986

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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