Healthcare Provider Details

I. General information

NPI: 1831103290
Provider Name (Legal Business Name): VISION SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 TECUMSEH LN
EVANSVILLE IN
47715-3220
US

IV. Provider business mailing address

4810 TECUMSEH LN
EVANSVILLE IN
47715-3220
US

V. Phone/Fax

Practice location:
  • Phone: 812-475-0035
  • Fax: 812-477-4537
Mailing address:
  • Phone: 812-475-0035
  • Fax: 812-477-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001803
License Number StateIN

VIII. Authorized Official

Name: KIM SHORT
Title or Position: CONTROLLER
Credential: D.O.
Phone: 812-475-0035