=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699571166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISIONWORKS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2025
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 HARRISON BRIDGE RD STE 335-C
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29680-7134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-519-2851
-----------------------------------------------------
Fax | 864-894-8146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19100 RIDGEWOOD PKWY BUILDING 1 7TH FLOOR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78259-1834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-340-0129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------