Provider Demographics
NPI:1134573678
Name:GORDON SCHANZLIN NEW VISION INSTITUTE, INC. A PROFESSIONAL MEDICAL COR
Entity type:Organization
Organization Name:GORDON SCHANZLIN NEW VISION INSTITUTE, INC. A PROFESSIONAL MEDICAL COR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-455-6800
Mailing Address - Street 1:8910 UNIVERSITY CENTER LN
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1029
Mailing Address - Country:US
Mailing Address - Phone:858-455-6800
Mailing Address - Fax:858-455-0244
Practice Address - Street 1:8910 UNIVERSITY CENTER LN
Practice Address - Street 2:SUITE 800
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1029
Practice Address - Country:US
Practice Address - Phone:858-455-6800
Practice Address - Fax:858-455-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty