MEDICARE: VISION PARK DIAGNOSTICS, 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1760849897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION PARK DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3525
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77903-3525
Country	:	US
Telephone Number	:	361-485-9400
Fax Number	:	361-485-9933

Provider Business Practice Location Address
First Line	:	114 VISION PARK BLVD STE 100
Second Line	:
City	:	SHENANDOAH
State	:	TX
Zip	:	77384-3008
Country	:	US
Telephone Number	:	936-321-1700
Fax Number	:	936-273-8900

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAUL HOANG
Credential	:	D.O.
Telephone Number	:	361-652-0025

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/20/2016

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Directions to “VISION PARK DIAGNOSTICS, LLC ” Practice Location

Language	Start Address	Practice Location

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