MEDICARE: VISIONARY EYEWEAR, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1033273958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONARY EYEWEAR, LLC

Provider Business Mailing Address
First Line	:	PO BOX 441
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-0441
Country	:	US
Telephone Number	:	217-347-3939
Fax Number	:	217-347-2932

Provider Business Practice Location Address
First Line	:	903 MEDICAL PARK DR
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2190
Country	:	US
Telephone Number	:	217-347-2933
Fax Number	:	217-347-2932

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ERIC C ZELLER
Credential	:
Telephone Number	:	217-347-3939

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/22/2020

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Directions to “VISIONARY EYEWEAR, LLC ” Practice Location

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