Provider Demographics
NPI:1083402671
Name:ENVISION OPTOMETRY LLC
Entity type:Organization
Organization Name:ENVISION OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AYLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-201-8585
Mailing Address - Street 1:205 ARCHELLE DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1956
Mailing Address - Country:US
Mailing Address - Phone:618-201-8585
Mailing Address - Fax:
Practice Address - Street 1:102 E DEYOUNG ST STE C
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2724
Practice Address - Country:US
Practice Address - Phone:618-201-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty