Provider Demographics
NPI:1790158780
Name:ENVISIONS IN VISIONS LLC
Entity Type:Organization
Organization Name:ENVISIONS IN VISIONS LLC
Other - Org Name:ENVISIONS EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-596-9393
Mailing Address - Street 1:362 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1045
Mailing Address - Country:US
Mailing Address - Phone:718-596-9393
Mailing Address - Fax:718-596-9699
Practice Address - Street 1:362 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1045
Practice Address - Country:US
Practice Address - Phone:718-596-9393
Practice Address - Fax:718-596-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier