Provider Demographics
NPI:1932321619
Name:I VISION LLC
Entity Type:Organization
Organization Name:I VISION LLC
Other - Org Name:EYE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:616-846-5220
Mailing Address - Street 1:110 S LAKE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1984
Mailing Address - Country:US
Mailing Address - Phone:616-846-5220
Mailing Address - Fax:616-846-7728
Practice Address - Street 1:110 S LAKE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1984
Practice Address - Country:US
Practice Address - Phone:616-846-5220
Practice Address - Fax:616-846-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1323790001Medicare NSC