Healthcare Provider Details

I. General information

NPI: 1992894455
Provider Name (Legal Business Name): VISIONWORKS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 RANDALL PARK MALL
NORTH RANDALL OH
44128
US

IV. Provider business mailing address

11103 WEST AVE SUITE #6
SAN ANTONIO TX
78213-1370
US

V. Phone/Fax

Practice location:
  • Phone: 216-663-4832
  • Fax: 216-663-9698
Mailing address:
  • Phone: 210-524-6663
  • 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: DOUG NEWCOM
Title or Position: OFFICER
Credential:
Phone: 210-524-6700