Basic Information
| Provider Information | |||||||||
| NPI: | 1124154299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INVISION OPTOMETRY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17620 W LUNDBERG ST | ||||||||
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| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853883134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735027264 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6145 N 35TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850171940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029736567 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | GANGJI | ||||||||
| AuthorizedOfficialFirstName: | HUSSEIN | ||||||||
| AuthorizedOfficialMiddleName: | SHERALI | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7735027264 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1500 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.