Provider Demographics
NPI:1194323923
Name:VIBRANT EYECARE, PLLC
Entity type:Organization
Organization Name:VIBRANT EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:210-932-9754
Mailing Address - Street 1:2310 SW MILITARY DR STE 248B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1409
Mailing Address - Country:US
Mailing Address - Phone:210-932-9754
Mailing Address - Fax:210-932-0495
Practice Address - Street 1:2310 SW MILITARY DR STE 248B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1409
Practice Address - Country:US
Practice Address - Phone:210-932-9754
Practice Address - Fax:210-932-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty