Provider Demographics
NPI:1225191802
Name:VISIONSMITH INC
Entity Type:Organization
Organization Name:VISIONSMITH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-383-0486
Mailing Address - Street 1:13345 32ND AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2635
Mailing Address - Country:US
Mailing Address - Phone:763-383-0486
Mailing Address - Fax:763-383-0486
Practice Address - Street 1:4190 VINEWOOD LN N
Practice Address - Street 2:SUITE 109
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1735
Practice Address - Country:US
Practice Address - Phone:763-559-5522
Practice Address - Fax:763-559-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty