=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013015114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION OPTICS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 08/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 SIDNEY BAKER ST STE B
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-2737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-792-5880
-----------------------------------------------------
Fax | 830-792-4950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 SIDNEY BAKER ST STE B
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-2737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-792-5880
-----------------------------------------------------
Fax | 830-792-4950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL
-----------------------------------------------------
Name | PETER J ROTHERMEL
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 830-792-5880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 04937T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------