Provider Demographics
NPI:1225700917
Name:CONQUESTS VISION INC
Entity Type:Organization
Organization Name:CONQUESTS VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKESHIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CONQUEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-316-4414
Mailing Address - Street 1:2005 OLD GREENBRIER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2649
Mailing Address - Country:US
Mailing Address - Phone:757-876-7057
Mailing Address - Fax:
Practice Address - Street 1:2005 OLD GREENBRIER RD STE 104
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2649
Practice Address - Country:US
Practice Address - Phone:757-876-7057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date: