Healthcare Provider Details

I. General information

NPI: 1902040918
Provider Name (Legal Business Name): VISIONWORKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5765 NORTHWEST HWY STE. 106
CRYSTAL LAKE IL
60014-8018
US

IV. Provider business mailing address

PO BOX 848448
DALLAS TX
75284-8448
US

V. Phone/Fax

Practice location:
  • Phone: 815-444-0662
  • Fax: 815-444-0553
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: DOROTHY REYNOLDS
Title or Position: DIRECTOR OF MANAGED VISION CARE
Credential:
Phone: 210-524-6515