Basic Information
| Provider Information | |||||||||
| NPI: | 1619247616 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VISION ON SITE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 E US HIGHWAY 80 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FORNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751268615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725522020 | ||||||||
| FaxNumber: | 9725521701 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 E US HIGHWAY 80 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FORNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751268615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725522020 | ||||||||
| FaxNumber: | 9725521701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2012 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | TARRANT | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9725522020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.