Healthcare Provider Details

I. General information

NPI: 1851643993
Provider Name (Legal Business Name): MVP VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2012
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 FALL RIVER AVE WALMART VISION CENTER
SEEKONK MA
02771
US

IV. Provider business mailing address

PO BOX 8429
CRANSTON RI
02920-0429
US

V. Phone/Fax

Practice location:
  • Phone: 508-336-5115
  • Fax: 508-336-6913
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00539
License Number StateRI

VIII. Authorized Official

Name: DR. MICHAEL V PETERS
Title or Position: OWNER
Credential: OD
Phone: 508-336-5115