MEDICARE: VISIONWORKS, 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
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1760898456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONWORKS, INC

Provider Business Mailing Address
First Line	:	PO BOX 848448
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8448
Country	:	US
Telephone Number	:	210-524-6771
Fax Number	:

Provider Business Practice Location Address
First Line	:	6570 N ILLINOIS ST
Second Line	:	SUITE A
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2195
Country	:	US
Telephone Number	:	618-628-3502
Fax Number	:	618-628-3515

Authorized Official
Title or Position	:	DIRECTOR MVC
Name	:	DOROTHY REYNOLDS
Credential	:
Telephone Number	:	210-524-6515

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	01/28/2015

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Directions to “VISIONWORKS, INC ” Practice Location

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