Provider Demographics
NPI:1528113230
Name:VISION BOUTIQUE INC
Entity type:Organization
Organization Name:VISION BOUTIQUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,MANAGER,LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-482-9883
Mailing Address - Street 1:212 W DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6522
Mailing Address - Country:US
Mailing Address - Phone:704-482-9883
Mailing Address - Fax:704-482-9842
Practice Address - Street 1:212 W DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6522
Practice Address - Country:US
Practice Address - Phone:704-482-9883
Practice Address - Fax:704-482-9842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0528332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment