Provider Demographics
NPI:1861659534
Name:FIRST VISION, INC.
Entity Type:Organization
Organization Name:FIRST VISION, INC.
Other - Org Name:SURECHOICE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:OBASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-649-5644
Mailing Address - Street 1:9100 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4814
Mailing Address - Country:US
Mailing Address - Phone:310-649-5644
Mailing Address - Fax:310-649-5536
Practice Address - Street 1:9100 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4849
Practice Address - Country:US
Practice Address - Phone:310-649-5644
Practice Address - Fax:310-649-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49260332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6136190001Medicare NSC