Provider Demographics
NPI:1295860666
Name:SVS VISION INC
Entity Type:Organization
Organization Name:SVS VISION INC
Other - Org Name:SVS VISION 42
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
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 1:140 MACOMB PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5651
Mailing Address - Country:US
Mailing Address - Phone:586-468-7370
Mailing Address - Fax:586-468-7682
Practice Address - Street 1:8212 N LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-7107
Practice Address - Country:US
Practice Address - Phone:314-423-2220
Practice Address - Fax:314-695-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4109640001Medicare ID - Type Unspecified