Provider Demographics
NPI:1952722068
Name:VIBRANT VISION CARE
Entity Type:Organization
Organization Name:VIBRANT VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-737-9615
Mailing Address - Street 1:537 JOHANSEN EXPY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3165
Mailing Address - Country:US
Mailing Address - Phone:907-451-9938
Mailing Address - Fax:888-724-3239
Practice Address - Street 1:537 JOHANSEN EXPY
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3165
Practice Address - Country:US
Practice Address - Phone:907-451-9938
Practice Address - Fax:888-724-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty