Provider Demographics
NPI:1073888103
Name:SURGERY BY VOLD VISION
Entity Type:Organization
Organization Name:SURGERY BY VOLD VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:VOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-442-8653
Mailing Address - Street 1:2783 N SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6983
Mailing Address - Country:US
Mailing Address - Phone:479-442-8653
Mailing Address - Fax:479-442-2678
Practice Address - Street 1:2783 N SHILOH DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-6983
Practice Address - Country:US
Practice Address - Phone:479-442-8653
Practice Address - Fax:479-442-2678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical