1770912149 NPI number — GLOBAL VISION FOUNDATION, INC.

Table of content: (NPI 1770912149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770912149 NPI number — GLOBAL VISION FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLOBAL VISION FOUNDATION, 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:
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:
1770912149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12108 EARLY LILACS PATH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21029-1676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-963-5870
Provider Business Mailing Address Fax Number:
240-264-6155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9171 CENTRAL AVE
Provider Second Line Business Practice Location Address:
UNITS B11 & B12
Provider Business Practice Location Address City Name:
CAPITOL HEIGHTS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20743-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-294-6058
Provider Business Practice Location Address Fax Number:
240-640-6155
Provider Enumeration Date:
11/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
OPESANMI
Authorized Official First Name:
TOYIN
Authorized Official Middle Name:
O
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
410-963-5870

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D0059876 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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