Healthcare Provider Details

I. General information

NPI: 1164618401
Provider Name (Legal Business Name): VISION SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W HONEY CREEK PKWY
TERRE HAUTE IN
47802-4114
US

IV. Provider business mailing address

4810 TECUMSEH LN
EVANSVILLE IN
47715-3220
US

V. Phone/Fax

Practice location:
  • Phone: 812-234-6500
  • Fax: 812-232-8921
Mailing address:
  • Phone: 812-475-0035
  • Fax: 812-477-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number18001803
License Number StateIN

VIII. Authorized Official

Name: DR. CHARLES RICHARD TAYLOR
Title or Position: OWNER
Credential: O.D.
Phone: 812-475-0035