=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760517650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SVS VISION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 06/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36383 26 MILE RD
-----------------------------------------------------
City | LENOX
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48048-3164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-648-5990
-----------------------------------------------------
Fax | 586-270-1532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 CASS AVE
-----------------------------------------------------
City | MOUNT CLEMENS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48043-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-468-7370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MR. ROBERT G FARRELL JR.
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 586-468-7370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------