Provider Demographics
NPI:1588225510
Name:VIBRANT VISION AND OPTICAL, INC.
Entity Type:Organization
Organization Name:VIBRANT VISION AND OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:971-377-1120
Mailing Address - Street 1:4285 COMMERCIAL ST SE STE 140
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4372
Mailing Address - Country:US
Mailing Address - Phone:971-377-1120
Mailing Address - Fax:
Practice Address - Street 1:4285 COMMERCIAL ST SE STE 140
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4372
Practice Address - Country:US
Practice Address - Phone:971-377-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty