Provider Demographics
NPI:1841213311
Name:VISIONQUEST LAB
Entity Type:Organization
Organization Name:VISIONQUEST LAB
Other - Org Name:VISIONQUEST LAB 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JEPPESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-917-1001
Mailing Address - Street 1:177 N INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7414
Mailing Address - Country:US
Mailing Address - Phone:386-917-1001
Mailing Address - Fax:
Practice Address - Street 1:177 N INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7414
Practice Address - Country:US
Practice Address - Phone:386-917-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier