Healthcare Provider Details

I. General information

NPI: 1447319355
Provider Name (Legal Business Name): VISION MAX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 N SUSQUEHANNA TRAIL
SELINSGROVE PA
17870
US

IV. Provider business mailing address

1026 N SUSQUEHANNA TRAIL
SELINSGROVE PA
17870
US

V. Phone/Fax

Practice location:
  • Phone: 570-374-8981
  • Fax:
Mailing address:
  • Phone: 570-374-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000436
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number6000006789
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOB008703
License Number StatePA

VIII. Authorized Official

Name: MR. STEVEN MICHAEL KRINER
Title or Position: OWNER
Credential:
Phone: 570-374-8981