Provider Demographics
NPI:1700200227
Name:MOBILE VISION LLC
Entity Type:Organization
Organization Name:MOBILE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRICKER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-740-5814
Mailing Address - Street 1:1737 SPRING ARBOR RD # 164
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1737 SPRING ARBOR RD # 164
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2701
Practice Address - Country:US
Practice Address - Phone:517-740-5814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty