Healthcare Provider Details

I. General information

NPI: 1366491227
Provider Name (Legal Business Name): VISION MART INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 W CARMEN AVE
MILWAUKEE WI
53225-2116
US

IV. Provider business mailing address

12000 W CARMEN AVE
MILWAUKEE WI
53225-2116
US

V. Phone/Fax

Practice location:
  • Phone: 414-462-1300
  • Fax:
Mailing address:
  • Phone: 414-462-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MS. VICKI DICKMAN
Title or Position: PRESIDENT
Credential:
Phone: 414-462-1300