Provider Demographics
NPI:1881117109
Name:SUMMIT VISION INC.
Entity type:Organization
Organization Name:SUMMIT VISION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESTER
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:904-993-1800
Mailing Address - Street 1:4408 GRAY HERON LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2660
Mailing Address - Country:US
Mailing Address - Phone:904-993-1800
Mailing Address - Fax:
Practice Address - Street 1:3416 MONCRIEF RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-4340
Practice Address - Country:US
Practice Address - Phone:904-861-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy