Provider Demographics
NPI:1922721554
Name:ENVISION EYECARE PLLC
Entity Type:Organization
Organization Name:ENVISION EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JERJOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:484-664-0035
Mailing Address - Street 1:14701 RIVER WALK WAY APT 134
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5955
Mailing Address - Country:US
Mailing Address - Phone:484-664-0035
Mailing Address - Fax:
Practice Address - Street 1:217 GARRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1527
Practice Address - Country:US
Practice Address - Phone:540-659-6983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty