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General NPI Number Information
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NPI Number | 1083402671
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Entity Type | Organization
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Legal Business Name | ENVISION OPTOMETRY LLC
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 102 E DEYOUNG ST STE C
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City | MARION
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State | IL
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Zip | 62959-2724
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Country | US
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Telephone | 618-201-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 205 ARCHELLE DR
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City | CARBONDALE
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State | IL
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Zip | 62901-1956
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Country | US
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Telephone | 618-201-8585
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY AYLESWORTH
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Credential | OD
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Telephone | 618-201-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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