Provider Demographics
NPI:1154505063
Name:VISUAL FX VISION CENTERS, LLC
Entity Type:Organization
Organization Name:VISUAL FX VISION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CLOSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-376-6328
Mailing Address - Street 1:7000 PEACH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509
Mailing Address - Country:US
Mailing Address - Phone:814-866-3030
Mailing Address - Fax:814-464-2953
Practice Address - Street 1:7000 PEACH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509
Practice Address - Country:US
Practice Address - Phone:814-866-3030
Practice Address - Fax:814-464-2953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA128618OtherMEDICARE HIGHMARK MEDICARE SERVICES
PA6127570001Medicare NSC