Organization Name: | CONSOLIDATED VISION GROUP |
NPI Number: | 1285806281 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHAWN T. MONAHAN (DIRECTOR, MANAGED CARE) |
Mailing Address: | 6375 Ulali Drive Keizer |
State: | OR US |
Postal Code: | 97303 |
Phone Number: | 5034285096 |
Fax Number: | 5034637253 |
NPI Enumeration Date: | 03/31/2008 |
NPI Last Update Date: | 01/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |