=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336342005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISIONWORKS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2007
-----------------------------------------------------
Last Update Date | 08/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7110 CERMAK RD
-----------------------------------------------------
City | BERWYN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60402-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-447-8214
-----------------------------------------------------
Fax | 708-442-0854
-----------------------------------------------------
=====================================================
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 | MANAGER
-----------------------------------------------------
Name | DOLSIE MCDONALD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 726-444-4078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------