Provider Demographics
NPI:1083394811
Name:GRAND VISION LLC
Entity Type:Organization
Organization Name:GRAND VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:TRIMIKA
Authorized Official - Last Name:SCONIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-270-0662
Mailing Address - Street 1:893 US 70 HWY W STE 200
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2597
Mailing Address - Country:US
Mailing Address - Phone:984-270-0662
Mailing Address - Fax:
Practice Address - Street 1:893 US 70 HWY W STE 200
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2597
Practice Address - Country:US
Practice Address - Phone:984-270-0662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care