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General NPI Number Information
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NPI Number | 1144045808
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Entity Type | Organization
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Legal Business Name | VISION GALLERY 417 LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 1961 S GLENSTONE AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2304
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Country | US
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Telephone | 417-323-2448
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Fax |
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Provider Business Mailing Address
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Address Line | 2042 S CELEBRATION AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65809-3529
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Country | US
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Telephone | 417-323-2448
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SUMMER WILLIAMSON
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Credential | OD
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Telephone | 417-323-2448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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