Provider Demographics
NPI:1548439839
Name:INVISION FAMILY EYECARE OD PLLC
Entity type:Organization
Organization Name:INVISION FAMILY EYECARE OD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LASHETA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-795-3937
Mailing Address - Street 1:6167 BAYFIELD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7486
Mailing Address - Country:US
Mailing Address - Phone:704-795-3937
Mailing Address - Fax:704-795-1577
Practice Address - Street 1:6167 BAYFIELD PARKWAY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7486
Practice Address - Country:US
Practice Address - Phone:704-795-3937
Practice Address - Fax:704-795-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093H3OtherBCBS OF NC STATE HEALTH CHOICE
NC093H3OtherBLUE CROSS BLUE SHIELD OF NC
NC890915NMedicaid
NC093H3OtherBCBS OF NC STATE HEALTH CHOICE