Provider Demographics
NPI:1679775126
Name:MOBILE VISION PROVIDERS, INC.
Entity Type:Organization
Organization Name:MOBILE VISION PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:LAYTON
Authorized Official - Last Name:LAPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-212-3208
Mailing Address - Street 1:1717 HIDDEN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-1651
Mailing Address - Country:US
Mailing Address - Phone:815-212-3208
Mailing Address - Fax:
Practice Address - Street 1:585 RIVER OAKS W
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5443
Practice Address - Country:US
Practice Address - Phone:708-891-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty