Healthcare Provider Details

I. General information

NPI: 1093103541
Provider Name (Legal Business Name): SOUTHWEST VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S US HIGHWAY 131 SUITE B
THREE RIVERS MI
49093-8835
US

IV. Provider business mailing address

314 S US HIGHWAY 131 SUITE B
THREE RIVERS MI
49093-8835
US

V. Phone/Fax

Practice location:
  • Phone: 989-289-2669
  • Fax:
Mailing address:
  • Phone: 989-289-2669
  • 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: PRESIDENT
Credential: OD
Phone: 989-289-2669