Healthcare Provider Details

I. General information

NPI: 1003368713
Provider Name (Legal Business Name): SOUTHWEST VISION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 E FRONT ST SUITE B4
BUCHANAN MI
49107-8474
US

IV. Provider business mailing address

1045 E FRONT ST SUITE B4
BUCHANAN MI
49107-8474
US

V. Phone/Fax

Practice location:
  • Phone: 269-695-9011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004625
License Number StateMI

VIII. Authorized Official

Name: JENNIFER LAMBART
Title or Position: OWNER
Credential:
Phone: 989-289-2669