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General NPI Number Information
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NPI Number | 1912169558
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Entity Type | Organization
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Legal Business Name | ENVISION EYEWEAR LLC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 29101 HEALTH CAMPUS DR SUITE 380
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City | WESTLAKE
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State | OH
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Zip | 44145-5270
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Country | US
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Telephone | 440-892-6699
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Fax | 440-925-3901
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Provider Business Mailing Address
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Address Line | 29101 HEALTH CAMPUS DR SUITE 380
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City | WESTLAKE
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State | OH
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Zip | 44145-5270
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Country | US
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Telephone | 440-892-6699
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Fax | 440-925-3901
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JOSEPH JOHN ROSS
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Credential | M.D.
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Telephone | 440-892-6699
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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 |
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License Number State | OH
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