Provider Demographics
NPI:1669698387
Name:ST CROIX VISION CENTER INC
Entity type:Organization
Organization Name:ST CROIX VISION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASCHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:340-773-2020
Mailing Address - Street 1:PO BOX 5996
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5996
Mailing Address - Country:US
Mailing Address - Phone:340-773-2020
Mailing Address - Fax:340-778-0977
Practice Address - Street 1:4500 SION FARM UNIT #2
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-773-2020
Practice Address - Fax:340-778-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI86482332H00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI069Medicaid
VIH1013AMedicare PIN