Provider Demographics
NPI:1235461708
Name:FULL SAIL PARTNERS, LLC
Entity Type:Organization
Organization Name:FULL SAIL PARTNERS, LLC
Other - Org Name:VISION CENTER OF PLYMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-936-8144
Mailing Address - Street 1:215 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-2134
Mailing Address - Country:US
Mailing Address - Phone:574-936-8144
Mailing Address - Fax:
Practice Address - Street 1:215 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-2134
Practice Address - Country:US
Practice Address - Phone:574-936-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty