Provider Demographics
NPI:1831522952
Name:VISION CARE MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:VISION CARE MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANTZ
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GOURGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-218-2024
Mailing Address - Street 1:447 PROSPECT ST
Mailing Address - Street 2:UNIT 38
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-3117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:447 PROSPECT ST
Practice Address - Street 2:UNIT 38
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-3117
Practice Address - Country:US
Practice Address - Phone:862-218-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100594OtherPROVIDER ID