Provider Demographics
NPI:1023207743
Name:OPTIVISION, LLP
Entity Type:Organization
Organization Name:OPTIVISION, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-729-6600
Mailing Address - Street 1:240 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2719
Mailing Address - Country:US
Mailing Address - Phone:920-729-6600
Mailing Address - Fax:920-729-6603
Practice Address - Street 1:240 1ST ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2719
Practice Address - Country:US
Practice Address - Phone:920-729-6600
Practice Address - Fax:920-729-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty