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	:	1851847396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONWORKS INC.

Provider Business Mailing Address
First Line	:	175 E. HOUSTON STREET
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2255
Country	:	US
Telephone Number	:	210-524-6982
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	12597 OLIVE BLVD.
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6311
Country	:	US
Telephone Number	:	314-628-9366
Fax Number	:	314-628-9603

Authorized Official
Title or Position	:	VP RETAIL MANAGED CARE
Name	:	DOROTHY REYNOLDS
Credential	:
Telephone Number	:	210-524-6515

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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Directions to “VISIONWORKS INC. ” Practice Location

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