Provider Demographics
NPI:1215221049
Name:VIBRANT VISION, INC
Entity Type:Organization
Organization Name:VIBRANT VISION, INC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-785-3133
Mailing Address - Street 1:1340 WILLOWBROOK MALL
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6904
Mailing Address - Country:US
Mailing Address - Phone:973-785-3133
Mailing Address - Fax:973-785-4322
Practice Address - Street 1:1340 WILLOWBROOK MALL
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6904
Practice Address - Country:US
Practice Address - Phone:973-785-3133
Practice Address - Fax:973-785-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3019332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier