Provider Demographics
NPI:1467606129
Name:VISION PRO II, INC
Entity Type:Organization
Organization Name:VISION PRO II, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-392-6222
Mailing Address - Street 1:3150 S POKEGAMA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-9020
Mailing Address - Country:US
Mailing Address - Phone:218-327-0070
Mailing Address - Fax:218-327-0070
Practice Address - Street 1:3150 S POKEGAMA AVE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-9020
Practice Address - Country:US
Practice Address - Phone:218-327-0070
Practice Address - Fax:218-327-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0589270001Medicare NSC