MEDICARE: VISION CARE CENTER

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	332BC3200X	Customized Equipment (DME)	152437	AZ

General Provider Information

NPI Number	:	1225162738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION CARE CENTER

Provider Business Mailing Address
First Line	:	1761 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-0947
Country	:	US
Telephone Number	:	928-453-1761
Fax Number	:	928-680-5806

Provider Business Practice Location Address
First Line	:	1761 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-0947
Country	:	US
Telephone Number	:	928-453-1761
Fax Number	:	928-680-5806

Authorized Official
Title or Position	:	OWNER
Name	:	MARIE M SUMINSKI
Credential	:
Telephone Number	:	928-453-1761

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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Directions to “VISION CARE CENTER ” Practice Location

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