Provider Demographics
NPI:1134412232
Name:VIP OPTICAL LLC
Entity type:Organization
Organization Name:VIP OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-650-2020
Mailing Address - Street 1:601 PROVIDENCE PARK DR E
Mailing Address - Street 2:SUITE O
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4617
Mailing Address - Country:US
Mailing Address - Phone:251-650-2000
Mailing Address - Fax:251-650-1010
Practice Address - Street 1:601 PROVIDENCE PARK DR E
Practice Address - Street 2:SUITE O
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4617
Practice Address - Country:US
Practice Address - Phone:251-650-2000
Practice Address - Fax:251-650-1010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISION PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9336332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier