Healthcare Provider Details

I. General information

NPI: 1356422547
Provider Name (Legal Business Name): VISIONWORKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 A SOUTH WOODLAND BOULEVARD
DE LAND FL
32720
US

IV. Provider business mailing address

PO BOX 844436
DALLAS TX
75284-4436
US

V. Phone/Fax

Practice location:
  • Phone: 386-736-3554
  • Fax: 386-736-6447
Mailing address:
  • Phone: 210-524-6663
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DOUG NEWCOM
Title or Position: OFFICER
Credential:
Phone: 210-524-6700