Provider Demographics
NPI:1215567987
Name:VIBRANT VISION LLC
Entity Type:Organization
Organization Name:VIBRANT VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARKITTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-592-3641
Mailing Address - Street 1:PO BOX 340120
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-0120
Mailing Address - Country:US
Mailing Address - Phone:210-223-1104
Mailing Address - Fax:
Practice Address - Street 1:2490 7TH ST BLDG 372
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7762
Practice Address - Country:US
Practice Address - Phone:210-223-1104
Practice Address - Fax:210-223-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty