Provider Demographics
NPI:1730372087
Name:HANNIBAL VISION CENTER, INC.
Entity type:Organization
Organization Name:HANNIBAL VISION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOLBER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-221-0040
Mailing Address - Street 1:413 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-4407
Mailing Address - Country:US
Mailing Address - Phone:573-221-0040
Mailing Address - Fax:573-221-1891
Practice Address - Street 1:413 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-4407
Practice Address - Country:US
Practice Address - Phone:573-221-0040
Practice Address - Fax:573-221-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier