Provider Demographics
NPI:1336393198
Name:INNERVISION OPTICAL LLC.
Entity Type:Organization
Organization Name:INNERVISION OPTICAL LLC.
Other - Org Name:INNERVISION FINE EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTICIAN/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-832-0350
Mailing Address - Street 1:1700 SANSOM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5234
Mailing Address - Country:US
Mailing Address - Phone:215-832-0350
Mailing Address - Fax:215-832-0357
Practice Address - Street 1:1700 SANSOM ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5234
Practice Address - Country:US
Practice Address - Phone:215-832-0350
Practice Address - Fax:215-832-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty