Provider Demographics
NPI:1275668543
Name:SVS VISION INC
Entity Type:Organization
Organization Name:SVS VISION INC
Other - Org Name:SVS VISION 2
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:586-468-7370
Mailing Address - Street 1:118 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2204
Mailing Address - Country:US
Mailing Address - Phone:586-468-7370
Mailing Address - Fax:586-468-7682
Practice Address - Street 1:5249 DETROIT RD
Practice Address - Street 2:UNITE B
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44054-2902
Practice Address - Country:US
Practice Address - Phone:440-934-3267
Practice Address - Fax:440-934-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
OH332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4109640001Medicare ID - Type Unspecified