Healthcare Provider Details

I. General information

NPI: 1538578406
Provider Name (Legal Business Name): VISION PRO II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E SUPERIOR ST SUITE #111
DULUTH MN
55802-2222
US

IV. Provider business mailing address

600 E SUPERIOR ST SUITE #111
DULUTH MN
55802-2222
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-4212
  • Fax: 218-722-4212
Mailing address:
  • Phone: 218-722-4212
  • Fax: 218-722-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE LOU FREY
Title or Position: VP-OPERATIONS
Credential:
Phone: 715-392-6222