Provider Demographics
NPI:1356476238
Name:SVS VISION INC
Entity Type:Organization
Organization Name:SVS VISION INC
Other - Org Name:SVS VISION 17
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
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:586-464-1479
Mailing Address - Fax:586-464-1480
Practice Address - Street 1:2500 E BELTLINE AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5987
Practice Address - Country:US
Practice Address - Phone:616-245-6300
Practice Address - Fax:616-245-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4500347Medicaid
MI4109640001Medicare PIN