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General NPI Number Information
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NPI Number | 1972948024
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Entity Type | Organization
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Legal Business Name | ENVOLVE TOTAL VISION, INC.
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 110 ZEBULON COURT
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2420
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Country | US
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Telephone | 800-334-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 112 ZEBULON COURT
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2420
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Country | US
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Telephone | 800-334-3937
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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. DAVID MICHAEL LAVELY
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Credential | O.D.
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Telephone | 252-544-9200
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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 |
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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