Provider Demographics
NPI:1699961565
Name:VISION MOBILE X-RAY SERVICES
Entity type:Organization
Organization Name:VISION MOBILE X-RAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:800-527-8133
Mailing Address - Street 1:2609 BROOK STONE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2408
Mailing Address - Country:US
Mailing Address - Phone:757-676-5717
Mailing Address - Fax:757-465-6018
Practice Address - Street 1:2609 BROOK STONE DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2408
Practice Address - Country:US
Practice Address - Phone:757-676-5717
Practice Address - Fax:757-465-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0120000428261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004998146Medicaid
VA630000019Medicare PIN