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NPI Code Detail

MEDICARE: VISIONS OPTICAL, P.C.

MEDICARE: VISIONS OPTICAL, P.C.
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1205064656
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISIONS OPTICAL, P.C.
Provider Business Mailing Address
First Line : 5014 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6804
Country : US
Telephone Number : 260-432-4060
Fax Number : 260-436-7475
Provider Business Practice Location Address
First Line : 5014 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6804
Country : US
Telephone Number : 260-432-4060
Fax Number : 260-436-7475
Authorized Official
Title or Position : OWNER
Name : DR. MONA RUTH DEWART
Credential : O.D.
Telephone Number : 260-432-4060
Provider Enumeration Date : 06/24/2009
Last Update Date : 10/13/2009

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Directions to “VISIONS OPTICAL, P.C. ” Practice Location

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