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NPI Code Detail

MEDICARE: VISIONARY RETAIL MANAGEMENT CA INC.

MEDICARE: VISIONARY RETAIL MANAGEMENT CA INC.
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
1332H00000XEyewear Supplier

General Provider Information

NPI Number : 1235966219
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISIONARY RETAIL MANAGEMENT CA INC.
Provider Business Mailing Address
First Line : 175 E HOUSTON ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78205-2299
Country : US
Telephone Number : 210-524-6587
Fax Number :
Provider Business Practice Location Address
First Line : 3372 W CENTURY BLVD
Second Line :
City : INGLEWOOD
State : CA
Zip : 90303-1305
Country : US
Telephone Number : 424-732-7430
Fax Number : 424-447-1256
Authorized Official
Title or Position : MANAGER
Name : DOLSIE MCDONALD
Credential :
Telephone Number : 726-444-4078
Provider Enumeration Date : 09/16/2024
Last Update Date : 09/16/2024

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Directions to “VISIONARY RETAIL MANAGEMENT CA INC. ” Practice Location

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