Healthcare Provider Details

I. General information

NPI: 1407598808
Provider Name (Legal Business Name): VISIONWORKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30955 WOODWARD AVE STE 215
ROYAL OAK MI
48073-0801
US

IV. Provider business mailing address

175 E HOUSTON ST
SAN ANTONIO TX
78205-2299
US

V. Phone/Fax

Practice location:
  • Phone: 248-873-0069
  • Fax:
Mailing address:
  • Phone: 800-340-0129
  • 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: DOLSIE MCDONALD
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 726-444-4078