Provider Demographics
NPI:1568676609
Name:CUSTOM VISION, INC
Entity Type:Organization
Organization Name:CUSTOM VISION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-273-8080
Mailing Address - Street 1:3630 SW FAIRLAWN RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-3966
Mailing Address - Country:US
Mailing Address - Phone:785-273-8080
Mailing Address - Fax:785-273-2583
Practice Address - Street 1:3630 SW FAIRLAWN RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-3966
Practice Address - Country:US
Practice Address - Phone:785-273-8080
Practice Address - Fax:785-273-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty