=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568287217
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NK-VISION INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2024
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 HIGH ST
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02155-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-210-9851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 EMERSON ST
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02155-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-402-9573
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. VIVIAN CHRISTINA SCHAEFER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 318-402-9573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------