MEDICARE: VISION WORLD, 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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1578660858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION WORLD, INC.

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	SUITE 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1370
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	2915 26TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1555
Country	:	US
Telephone Number	:	612-724-4444
Fax Number	:	612-722-8323

Authorized Official
Title or Position	:	VP BUSINESS DEVELOPMENT
Name	:	DOUG NEWCOM
Credential	:
Telephone Number	:	210-524-6663

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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