Provider Demographics
NPI:1114476066
Name:VISION STORE LLC
Entity Type:Organization
Organization Name:VISION STORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-360-0033
Mailing Address - Street 1:3996 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9416
Mailing Address - Country:US
Mailing Address - Phone:954-360-0033
Mailing Address - Fax:954-421-7449
Practice Address - Street 1:3996 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9416
Practice Address - Country:US
Practice Address - Phone:954-360-0033
Practice Address - Fax:954-421-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier