Provider Demographics
NPI:1891018883
Name:VISION PRO OPTICAL
Entity Type:Organization
Organization Name:VISION PRO OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REG ADMIN MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:HOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-724-1341
Mailing Address - Street 1:1028 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1149
Mailing Address - Country:US
Mailing Address - Phone:218-834-3937
Mailing Address - Fax:218-834-3937
Practice Address - Street 1:1028 7TH AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1149
Practice Address - Country:US
Practice Address - Phone:218-834-3937
Practice Address - Fax:218-834-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty