1902988702 NPI number — CLEARR VISSION SUPPORT SERVICES, LLC

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 1902988702 NPI number — CLEARR VISSION SUPPORT SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEARR VISSION SUPPORT SERVICES, LLC
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:
1902988702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7818 CAMOLIN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23228-6400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-527-0992
Provider Business Mailing Address Fax Number:
804-271-8612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5812 NORTHFORD PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23832-7590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-271-7263
Provider Business Practice Location Address Fax Number:
804-271-8612
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HICKMAN
Authorized Official First Name:
DERWIN
Authorized Official Middle Name:
LAMONT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
804-527-0992

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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