Provider Demographics
NPI:1659719631
Name:NEW VISIONS OPTICAL, INC.
Entity Type:Organization
Organization Name:NEW VISIONS OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTANA
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:NOTTAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-315-5945
Mailing Address - Street 1:5310 EDMONDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2201
Mailing Address - Country:US
Mailing Address - Phone:443-315-5945
Mailing Address - Fax:800-670-8788
Practice Address - Street 1:5310 EDMONDSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2201
Practice Address - Country:US
Practice Address - Phone:443-315-5945
Practice Address - Fax:800-670-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03695969332B00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies