Healthcare Provider Details

I. General information

NPI: 1962509224
Provider Name (Legal Business Name): VISIONWORKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N FREDERICK AVE
GAITHERSBURG MD
20879-3306
US

IV. Provider business mailing address

175 E HOUSTON ST
SAN ANTONIO TX
78205-2255
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-4972
  • Fax: 301-330-4369
Mailing address:
  • Phone: 210-524-6803
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL POTH
Title or Position: OWNER
Credential: OD
Phone: 703-288-1978