Provider Demographics
NPI:1033380456
Name:CRYSTAL CLEAR VISION
Entity Type:Organization
Organization Name:CRYSTAL CLEAR VISION
Other - Org Name:RAMSDELLS OPTICIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEPANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-734-8195
Mailing Address - Street 1:307 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724
Mailing Address - Country:US
Mailing Address - Phone:386-734-8195
Mailing Address - Fax:386-734-0695
Practice Address - Street 1:307 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724
Practice Address - Country:US
Practice Address - Phone:386-734-8195
Practice Address - Fax:386-734-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0869560001Medicare NSC