Provider Demographics
NPI:1043228380
Name:NANCE, VINSON E (OD)
Entity Type:Individual
Prefix:DR
First Name:VINSON
Middle Name:E
Last Name:NANCE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11365 MONTWOOD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3854
Mailing Address - Country:US
Mailing Address - Phone:915-857-3997
Mailing Address - Fax:915-857-1203
Practice Address - Street 1:11365 MONTWOOD DR
Practice Address - Street 2:SUITE D
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3854
Practice Address - Country:US
Practice Address - Phone:915-857-3997
Practice Address - Fax:915-857-1203
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2742TG152W00000X
TX02742TG152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E07HMedicare PIN
0922830001Medicare NSC
TXT14988Medicare UPIN