Provider Demographics
NPI:1457692840
Name:CLEAR VISION, LLC
Entity Type:Organization
Organization Name:CLEAR VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STATEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MHSA
Authorized Official - Phone:210-273-9931
Mailing Address - Street 1:9832 LOGANS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2765
Mailing Address - Country:US
Mailing Address - Phone:210-273-9931
Mailing Address - Fax:
Practice Address - Street 1:1222 N MAIN AVE STE 740
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5711
Practice Address - Country:US
Practice Address - Phone:210-273-9931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX458635363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty