Provider Demographics
NPI:1114663606
Name:VISUAL EDGE LLC
Entity Type:Organization
Organization Name:VISUAL EDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALICKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-933-5137
Mailing Address - Street 1:227 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3413
Mailing Address - Country:US
Mailing Address - Phone:610-933-5137
Mailing Address - Fax:
Practice Address - Street 1:227 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3413
Practice Address - Country:US
Practice Address - Phone:610-933-5137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty