Provider Demographics
NPI:1649444993
Name:PROFESSIONAL VISION SERVICES INC
Entity type:Organization
Organization Name:PROFESSIONAL VISION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER OF PROFESSIONAL VISION
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CHANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-273-2478
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:PROFESSIONAL VISION SERVICES INC
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010
Mailing Address - Country:US
Mailing Address - Phone:229-273-2478
Mailing Address - Fax:229-271-2432
Practice Address - Street 1:115 7TH ST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31010
Practice Address - Country:US
Practice Address - Phone:229-273-2478
Practice Address - Fax:229-271-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty