Provider Demographics
NPI:1568771608
Name:VISION OPTICAL
Entity Type:Organization
Organization Name:VISION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:LISBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-298-0643
Mailing Address - Street 1:4344 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7436
Mailing Address - Country:US
Mailing Address - Phone:701-298-0643
Mailing Address - Fax:701-293-0909
Practice Address - Street 1:4344 20TH AVE SW
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7436
Practice Address - Country:US
Practice Address - Phone:701-298-0643
Practice Address - Fax:701-293-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier