Healthcare Provider Details

I. General information

NPI: 1659649036
Provider Name (Legal Business Name): VISION SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 MIAMISBURG CENTERVILLE RD
DAYTON OH
45459-3729
US

IV. Provider business mailing address

4810 TECUMSEH LN
EVANSVILLE IN
47715-3220
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-4060
  • Fax:
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 Number
License Number State

VIII. Authorized Official

Name: KIMBERLY ANN SHORT
Title or Position: CONTROLLER
Credential:
Phone: 81247500354