Basic Information
| Provider Information | |||||||||
| NPI: | 1407871320 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VISION MASTERS CORP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | VISION MASTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 706 GRAPE STREET | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102667700 | ||||||||
| FaxNumber: | 6102669300 | ||||||||
| Practice Location | |||||||||
| Address1: | 706 GRAPE STREET | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102667700 | ||||||||
| FaxNumber: | 6102669300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MIGNOGNA | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6102667700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OE 007828 T | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | OE007800T | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | OEG001256 | PA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.