Provider Demographics
NPI:1093225633
Name:SUCCESS VISION EXPRESS OF CONWAY
Entity Type:Organization
Organization Name:SUCCESS VISION EXPRESS OF CONWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-895-1700
Mailing Address - Street 1:5312 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-6110
Mailing Address - Country:US
Mailing Address - Phone:918-895-1700
Mailing Address - Fax:877-464-4002
Practice Address - Street 1:1100 S AMITY RD STE B
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8106
Practice Address - Country:US
Practice Address - Phone:918-895-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier