Provider Demographics
NPI:1649671488
Name:VISION AFFILIATES
Entity type:Organization
Organization Name:VISION AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-729-5303
Mailing Address - Street 1:5201 68TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1508
Mailing Address - Country:US
Mailing Address - Phone:806-798-9955
Mailing Address - Fax:800-240-8448
Practice Address - Street 1:5201 68TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1508
Practice Address - Country:US
Practice Address - Phone:806-798-9955
Practice Address - Fax:800-240-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty