Provider Demographics
NPI:1245721026
Name:DOUBLE VISION
Entity type:Organization
Organization Name:DOUBLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN/OWNER
Authorized Official - Phone:701-532-0788
Mailing Address - Street 1:1365 PRAIRIE PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-4049
Mailing Address - Country:US
Mailing Address - Phone:701-532-0788
Mailing Address - Fax:701-532-0988
Practice Address - Street 1:1365 PRAIRIE PKWY
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-4049
Practice Address - Country:US
Practice Address - Phone:701-532-0788
Practice Address - Fax:701-532-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier