Provider Demographics
NPI:1134276785
Name:VISION OPTICAL INC
Entity type:Organization
Organization Name:VISION OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DUBBELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-751-7255
Mailing Address - Street 1:1401 PAUL BUNYAN DR NW
Mailing Address - Street 2:PAUL BUNYAN MALL
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4155
Mailing Address - Country:US
Mailing Address - Phone:218-751-7255
Mailing Address - Fax:218-751-7256
Practice Address - Street 1:1401 PAUL BUNYAN DR NW
Practice Address - Street 2:PAUL BUNYAN MALL
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4155
Practice Address - Country:US
Practice Address - Phone:218-751-7255
Practice Address - Fax:218-751-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty