Provider Demographics
NPI:1225162738
Name:VISION CARE CENTER
Entity Type:Organization
Organization Name:VISION CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-453-1761
Mailing Address - Street 1:1761 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0947
Mailing Address - Country:US
Mailing Address - Phone:928-453-1761
Mailing Address - Fax:928-680-5806
Practice Address - Street 1:1761 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0947
Practice Address - Country:US
Practice Address - Phone:928-453-1761
Practice Address - Fax:928-680-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ152437332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4937440001Medicare ID - Type Unspecified