Provider Demographics
NPI:1306378849
Name:GLOBAL VISION SOURCES INC.
Entity Type:Organization
Organization Name:GLOBAL VISION SOURCES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLAKUNLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWUNMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-341-1240
Mailing Address - Street 1:7500 E DEER VALLEY RD
Mailing Address - Street 2:UNIT 155
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4814
Mailing Address - Country:US
Mailing Address - Phone:301-356-2656
Mailing Address - Fax:
Practice Address - Street 1:7500 E DEER VALLEY RD
Practice Address - Street 2:UNIT 155
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4814
Practice Address - Country:US
Practice Address - Phone:301-356-2656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1978302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1978Medicaid