=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013004381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISIONWORKS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 09/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 EAST KELLOG
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-681-1171
-----------------------------------------------------
Fax | 316-681-2736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 848448
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75284-8448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-524-6663
-----------------------------------------------------
Fax | 210-524-6587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | DOROTHY REYNOLDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-524-6515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------