=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598860793
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN VISION EYE CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 01/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 LIBERTY BELL LN SUITE 107
-----------------------------------------------------
City | COPPERAS COVE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76522-2587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-542-4040
-----------------------------------------------------
Fax | 254-449-7043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2924 S 31ST ST
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76502-1861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-770-2351
-----------------------------------------------------
Fax | 254-770-2299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CEO
-----------------------------------------------------
Name | MR. ANDREW KLEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 254-770-2351
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------