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General NPI Number Information
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NPI Number | 1679889778
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Entity Type | Organization
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Legal Business Name | VISION CONCEPTS
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 113 N LUTTERLOH AVE
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City | GATESVILLE
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State | TX
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Zip | 76528-1421
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Country | US
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Telephone | 254-865-7979
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Fax | 254-865-2605
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Provider Business Mailing Address
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Address Line | 113 N LUTTERLOH AVE
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City | GATESVILLE
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State | TX
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Zip | 76528-1421
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Country | US
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Telephone | 254-865-7979
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Fax | 254-865-2605
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MRS. MELISSA A BELLO
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Credential | O.D.
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Telephone | 254-865-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4428T
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License Number State | TX
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