Provider Demographics
NPI:1942480660
Name:VISIONS SIGHT & LEARNING CENTER
Entity Type:Organization
Organization Name:VISIONS SIGHT & LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPISI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-572-4805
Mailing Address - Street 1:23 CLARA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1959
Mailing Address - Country:US
Mailing Address - Phone:860-572-4805
Mailing Address - Fax:860-572-4810
Practice Address - Street 1:23 CLARA DRIVE
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1959
Practice Address - Country:US
Practice Address - Phone:860-572-4805
Practice Address - Fax:860-572-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002263152W00000X
RI00430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5049590001Medicare NSC
CT=========Medicare UPIN
CTU39333Medicare PIN