Provider Demographics
NPI:1952047284
Name:FRONTIER VISION LLC
Entity Type:Organization
Organization Name:FRONTIER VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-889-6522
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0697
Mailing Address - Country:US
Mailing Address - Phone:606-889-6522
Mailing Address - Fax:606-889-6453
Practice Address - Street 1:400 UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1080
Practice Address - Country:US
Practice Address - Phone:606-889-6522
Practice Address - Fax:606-889-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty