Provider Demographics
NPI:1093891426
Name:DESIGN FOR VISION OF RIVERVIEW LLC
Entity Type:Organization
Organization Name:DESIGN FOR VISION OF RIVERVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-479-5300
Mailing Address - Street 1:19216 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6702
Mailing Address - Country:US
Mailing Address - Phone:734-479-5300
Mailing Address - Fax:734-479-5367
Practice Address - Street 1:19216 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6702
Practice Address - Country:US
Practice Address - Phone:734-479-5300
Practice Address - Fax:734-479-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093891426OtherMEDICARE NSC
MI5814390001Medicare NSC