Provider Demographics
NPI:1447517792
Name:VISIONARY
Entity type:Organization
Organization Name:VISIONARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEGAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TENORIO
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:224-875-0729
Mailing Address - Street 1:1200 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-2305
Mailing Address - Country:US
Mailing Address - Phone:224-875-0729
Mailing Address - Fax:
Practice Address - Street 1:1200 GRANT DR
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-2305
Practice Address - Country:US
Practice Address - Phone:224-875-0729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier