MEDICARE: VISIONWORKS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1235406505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONWORKS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 848448
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8448
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	2033 MAPLEWOOD MALL
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1228
Country	:	US
Telephone Number	:	651-777-0330
Fax Number	:	651-770-5444

Authorized Official
Title or Position	:	MVC DIRECTOR
Name	:	DOROTHY REYNOLDS
Credential	:
Telephone Number	:	210-524-6515

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/27/2013

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