Provider Demographics
NPI:1104943521
Name:TOTAL VISION, INC.
Entity type:Organization
Organization Name:TOTAL VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-536-7584
Mailing Address - Street 1:PO BOX 2757
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-2757
Mailing Address - Country:US
Mailing Address - Phone:541-536-7584
Mailing Address - Fax:541-536-8579
Practice Address - Street 1:16487 BLUEWOOD PLACE
Practice Address - Street 2:SUITE 2
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739
Practice Address - Country:US
Practice Address - Phone:541-536-7584
Practice Address - Fax:541-536-8579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty