Provider Demographics
NPI:1003864976
Name:VISION ASSOCIATES, INC.
Entity Type:Organization
Organization Name:VISION ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTGOMERY
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-727-8321
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-0048
Mailing Address - Country:US
Mailing Address - Phone:304-727-8321
Mailing Address - Fax:304-727-8841
Practice Address - Street 1:223 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2821
Practice Address - Country:US
Practice Address - Phone:304-727-8321
Practice Address - Fax:304-727-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV701 O.D.152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150620000Medicaid
WV4321742OtherAETNA
WV0150620000Medicaid
WV4321742OtherAETNA
WVT32601Medicare UPIN