Provider Demographics
NPI:1174709604
Name:VISION MAX
Entity type:Organization
Organization Name:VISION MAX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-329-0188
Mailing Address - Street 1:247 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754
Mailing Address - Country:US
Mailing Address - Phone:570-329-0188
Mailing Address - Fax:570-329-0190
Practice Address - Street 1:247 BROAD STREET
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754
Practice Address - Country:US
Practice Address - Phone:570-329-0188
Practice Address - Fax:570-329-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET-08726-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAST-342569OtherCLARITY VISION
PA393860OtherNVA
PA52363OtherDAVIS VISION
PAPA-6839OtherEYE MED
PA5689930003Medicare NSC