Provider Demographics
NPI:1659629186
Name:FRANKLIN VISION GROUP, P.C.
Entity Type:Organization
Organization Name:FRANKLIN VISION GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:409-617-9774
Mailing Address - Street 1:333 S WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5519
Mailing Address - Country:US
Mailing Address - Phone:409-617-9774
Mailing Address - Fax:573-785-7387
Practice Address - Street 1:333 S WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5519
Practice Address - Country:US
Practice Address - Phone:573-785-2853
Practice Address - Fax:573-785-7387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty