Provider Demographics
NPI:1811018120
Name:VISION CENTER PC
Entity Type:Organization
Organization Name:VISION CENTER PC
Other - Org Name:ROBERT L FLOOD OD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-408-8762
Mailing Address - Street 1:2603 NILES AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1954
Mailing Address - Country:US
Mailing Address - Phone:269-408-8762
Mailing Address - Fax:269-408-8764
Practice Address - Street 1:2603 NILES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1954
Practice Address - Country:US
Practice Address - Phone:269-408-8762
Practice Address - Fax:269-408-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0264260001OtherMEDICARE DME
MI0264260001Medicare NSC