Provider Demographics
NPI:1306117080
Name:VISION PRO OPTICAL
Entity type:Organization
Organization Name:VISION PRO OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:HOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-392-6222
Mailing Address - Street 1:109 COURT AVE S
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-5120
Mailing Address - Country:US
Mailing Address - Phone:320-245-2637
Mailing Address - Fax:320-245-0417
Practice Address - Street 1:109 COURT AVE S
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5120
Practice Address - Country:US
Practice Address - Phone:320-245-2637
Practice Address - Fax:320-245-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty