Provider Demographics
NPI:1336488204
Name:NORTHWEST VISION GROUP
Entity Type:Organization
Organization Name:NORTHWEST VISION GROUP
Other - Org Name:INVISION EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:ORGAIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-856-3467
Mailing Address - Street 1:PO BOX 9628
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0028
Mailing Address - Country:US
Mailing Address - Phone:479-856-3467
Mailing Address - Fax:888-533-6054
Practice Address - Street 1:3215 E SUMMERSHADE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4375
Practice Address - Country:US
Practice Address - Phone:479-856-3467
Practice Address - Fax:888-533-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty