1831225705 NPI number — T VISION INC

Table of content: (NPI 1831225705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831225705 NPI number — T VISION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T 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:
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:
1831225705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6645 WILLOW PARK DR
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34109-8989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-513-9004
Provider Business Mailing Address Fax Number:
239-597-0333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6645 WILLOW PARK DR
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34109-8989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-513-9004
Provider Business Practice Location Address Fax Number:
239-597-0333
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRYANT
Authorized Official First Name:
T
Authorized Official Middle Name:
FOSTER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-513-9004

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8490 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 88306 . This is a "BCSB" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5808295 . This is a "GHI" identifier . This identifiers is of the category "OTHER".




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