Provider Demographics
NPI:1639929144
Name:TRIA VISION PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:TRIA VISION PHYSICIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-876-8988
Mailing Address - Street 1:PO BOX 59449
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35259-9449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:205-644-8485
Practice Address - Street 1:1819 5TH AVE N STE 1000
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-2118
Practice Address - Country:US
Practice Address - Phone:205-876-8988
Practice Address - Fax:205-644-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty