Provider Demographics
NPI:1194355917
Name:FR VISION 360, INC.
Entity type:Organization
Organization Name:FR VISION 360, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-391-4699
Mailing Address - Street 1:26 TIMBER VIEW RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62638-5073
Mailing Address - Country:US
Mailing Address - Phone:217-391-4699
Mailing Address - Fax:
Practice Address - Street 1:111 E MORTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3059
Practice Address - Country:US
Practice Address - Phone:217-883-4553
Practice Address - Fax:217-883-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier