Provider Demographics
NPI:1568988814
Name:SOUTHWEST VISION CENTER INC.
Entity Type:Organization
Organization Name:SOUTHWEST VISION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVEN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:LAMBART
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:269-240-4464
Mailing Address - Street 1:69001 M 62 STE E
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9131
Mailing Address - Country:US
Mailing Address - Phone:269-273-8588
Mailing Address - Fax:
Practice Address - Street 1:55021 M 51 N
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9664
Practice Address - Country:US
Practice Address - Phone:269-782-3476
Practice Address - Fax:269-782-6631
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST VISION CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty