Healthcare Provider Details

I. General information

NPI: 1659656924
Provider Name (Legal Business Name): VISIONWORKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VIEWMONT MALL SPACE 844
SCRANTON PA
18508
US

IV. Provider business mailing address

PO BOX 848448
DALLAS TX
75284-8448
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-2786
  • Fax:
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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1014503890015
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier4852140376
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE

VIII. Authorized Official

Name: DOROTHY REYNOLDS
Title or Position: DIRECTOR OF MANAGED VISION CARE
Credential:
Phone: 210-524-6515