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	:	1902789563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONWORKS INC.

Provider Business Mailing Address
First Line	:	19100 RIDGEWOOD PKWY BLDG. 1 7TH FLOOR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-1834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7689 S JORDAN LANDING BLVD STE 170
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-5692
Country	:	US
Telephone Number	:	385-525-3451
Fax Number	:	385-331-4142

Authorized Official
Title or Position	:	MANAGER
Name	:	DOLSIE MCDONALD
Credential	:
Telephone Number	:	726-444-4078

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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