Healthcare Provider Details

I. General information

NPI: 1215205679
Provider Name (Legal Business Name): EXODUS VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 LYELL AVE
ROCHESTER NY
14606-2040
US

IV. Provider business mailing address

2191 COLUMBIA AVE W
BATTLE CREEK MI
49015-2847
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-0022
  • Fax: 585-254-0132
Mailing address:
  • Phone: 269-968-1600
  • Fax: 269-968-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. PATRICK HO
Title or Position: CEO
Credential:
Phone: 585-254-0022