Provider Demographics
NPI:1619049731
Name:WEBVISION P.L.L.C.
Entity Type:Organization
Organization Name:WEBVISION P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:586-899-6076
Mailing Address - Street 1:34347 LILLIAN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3127
Mailing Address - Country:US
Mailing Address - Phone:586-725-0257
Mailing Address - Fax:586-421-1274
Practice Address - Street 1:45400 MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3279
Practice Address - Country:US
Practice Address - Phone:586-421-1274
Practice Address - Fax:586-421-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88060Medicare UPIN
0N65530Medicare ID - Type Unspecified