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General NPI Number Information
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NPI Number | 1093103541
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Entity Type | Organization
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Legal Business Name | SOUTHWEST VISION CENTER INC
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 314 S US HIGHWAY 131 SUITE B
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City | THREE RIVERS
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State | MI
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Zip | 49093-8835
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Country | US
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Telephone | 989-289-2669
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Fax |
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Provider Business Mailing Address
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Address Line | 314 S US HIGHWAY 131 SUITE B
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City | THREE RIVERS
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State | MI
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Zip | 49093-8835
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Country | US
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Telephone | 989-289-2669
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER LAMBART
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Credential | OD
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Telephone | 989-289-2669
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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 | 4901004625
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License Number State | MI
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