| Organization Name: | TOTAL VISION, INC. |
| NPI Number: | 1104943521 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANNON LEE JACKMAN (BILLING COORDINATOR) |
| Mailing Address: | 16487 Bluewood Place Suite 2 La Pine |
| State: | OR US |
| Postal Code: | 97739 |
| Phone Number: | 5415367584 |
| Fax Number: | 5415368579 |
| NPI Enumeration Date: | 03/22/2007 |
| NPI Last Update Date: | 09/25/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |