Provider Demographics
NPI:1093103541
Name:SOUTHWEST VISION CENTER INC
Entity Type:Organization
Organization Name:SOUTHWEST VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-289-2669
Mailing Address - Street 1:314 S US HIGHWAY 131
Mailing Address - Street 2:SUITE B
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8835
Mailing Address - Country:US
Mailing Address - Phone:989-289-2669
Mailing Address - Fax:
Practice Address - Street 1:314 S US HIGHWAY 131
Practice Address - Street 2:SUITE B
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8835
Practice Address - Country:US
Practice Address - Phone:989-289-2669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty