=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689735250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION CORRECTION CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 06/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1406 MCFARLAND BLVD N SUITE 2B
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35406-2293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-248-0095
-----------------------------------------------------
Fax | 205-345-9016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1406 MCFARLAND BLVD N SUITE 2B
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35406-2293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-248-0095
-----------------------------------------------------
Fax | 205-345-9016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DANIEL HOGUE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-248-0095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 01C0001041
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------