Provider Demographics
NPI:1306316914
Name:VIKING VISION, INC.
Entity type:Organization
Organization Name:VIKING VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VERACHTERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-516-9590
Mailing Address - Street 1:14960 NW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3829
Mailing Address - Country:US
Mailing Address - Phone:816-516-9590
Mailing Address - Fax:
Practice Address - Street 1:5769 NE ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-2017
Practice Address - Country:US
Practice Address - Phone:816-454-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty