Healthcare Provider Details

I. General information

NPI: 1669698387
Provider Name (Legal Business Name): ST CROIX VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SION FARM UNIT #2
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

PO BOX 5996
CHRISTIANSTED VI
00823-5996
US

V. Phone/Fax

Practice location:
  • Phone: 340-773-2020
  • Fax: 340-778-0977
Mailing address:
  • Phone: 340-773-2020
  • Fax: 340-778-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number86482
License Number StateVI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL F MASCHAUER
Title or Position: PRESIDENT
Credential: OD
Phone: 340-773-2020