Provider Demographics
NPI:1649327693
Name:VISION OPTICAL INC.
Entity type:Organization
Organization Name:VISION OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DUBBELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-326-1775
Mailing Address - Street 1:426 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2582
Mailing Address - Country:US
Mailing Address - Phone:218-326-1775
Mailing Address - Fax:218-326-3745
Practice Address - Street 1:426 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2582
Practice Address - Country:US
Practice Address - Phone:218-326-1775
Practice Address - Fax:218-326-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty