Provider Demographics
NPI:1790837763
Name:3-D VISION INCORPORATED
Entity Type:Organization
Organization Name:3-D VISION INCORPORATED
Other - Org Name:JUDY L DAVIS DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-531-1999
Mailing Address - Street 1:PO BOX 2023
Mailing Address - Street 2:807 GLENDALE BLVD
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-2023
Mailing Address - Country:US
Mailing Address - Phone:219-531-1999
Mailing Address - Fax:219-465-7569
Practice Address - Street 1:807 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46384-2023
Practice Address - Country:US
Practice Address - Phone:219-531-1999
Practice Address - Fax:219-465-7569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001245207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000090726OtherBCBS
180024221OtherTRAV MEDICARE
IN100376090Medicaid
IN000000090726OtherBCBS
F75253Medicare UPIN