Basic Information
Provider Information
NPI: 1285394858
EntityType: 2
ReplacementNPI:  
OrganizationName: VISIONWORKS, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 175 E HOUSTON ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782052255
CountryCode: US
TelephoneNumber: 8003400129
FaxNumber:  
Practice Location
Address1: 1217 POLARIS PKWY SPC 7A
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432402037
CountryCode: US
TelephoneNumber: 6147687861
FaxNumber: 6144309324
Other Information
ProviderEnumerationDate: 12/23/2021
LastUpdateDate: 08/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MCDONALD
AuthorizedOfficialFirstName: DOLSIE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CREDENTIALING MANAGER
AuthorizedOfficialTelephone: 2105246663
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332H00000X  Y SuppliersEyewear Supplier (Equipment, not the service) 

No ID Information.


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