Provider Demographics
NPI:1609906122
Name:SHARPER VISION INC
Entity Type:Organization
Organization Name:SHARPER VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:QUANG
Authorized Official - Middle Name:V
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:850-455-8155
Mailing Address - Street 1:800 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-3404
Mailing Address - Country:US
Mailing Address - Phone:850-455-8155
Mailing Address - Fax:850-458-4946
Practice Address - Street 1:2951 S BLUE ANGEL PKWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6906
Practice Address - Country:US
Practice Address - Phone:850-455-8155
Practice Address - Fax:850-458-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTAN AI813OtherMEDICARE PTAN