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General NPI Number Information
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NPI Number | 1144694852
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Entity Type | Organization
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Legal Business Name | IMPERIAL VISION
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 3964 NORTH SMEDLEY ST. APT C
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City | PHILADELPHIA
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State | PA
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Zip | 19140
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Country | US
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Telephone | 267-625-3379
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Fax |
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Provider Business Mailing Address
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Address Line | 3964 N SMEDLEY ST APT C
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City | PHILADELPHIA
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State | PA
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Zip | 19140-3421
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Country | US
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Telephone | 267-625-3379
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ANTONIO LEMONT JONES
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Credential |
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Telephone | 267-625-3379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 000000001
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License Number State | PA
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