Provider Demographics
NPI:1780820423
Name:STANISZEWSKI-PASQUA LLC
Entity Type:Organization
Organization Name:STANISZEWSKI-PASQUA LLC
Other - Org Name:NEW VISION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANISZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-724-7440
Mailing Address - Street 1:927 S OTSEGO AVE
Mailing Address - Street 2:P.O. BOX 421
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1783
Mailing Address - Country:US
Mailing Address - Phone:989-732-7518
Mailing Address - Fax:989-732-4205
Practice Address - Street 1:927 S OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1783
Practice Address - Country:US
Practice Address - Phone:989-732-7518
Practice Address - Fax:989-732-4205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANISZEWSKI-PASQUA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty