Provider Demographics
NPI:1740583152
Name:ENVISION OPTOMETRY, PC
Entity Type:Organization
Organization Name:ENVISION OPTOMETRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-345-3509
Mailing Address - Street 1:126 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110
Mailing Address - Country:US
Mailing Address - Phone:617-367-8537
Mailing Address - Fax:617-426-1503
Practice Address - Street 1:126 HIGH STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110
Practice Address - Country:US
Practice Address - Phone:617-367-8537
Practice Address - Fax:617-426-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty