Provider Demographics
NPI:1366039075
Name:VISION SURGICAL ARTS, LLC
Entity Type:Organization
Organization Name:VISION SURGICAL ARTS, LLC
Other - Org Name:ORAL FACIAL SURGERY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-251-6725
Mailing Address - Street 1:621 S NEW BALLAS RD STE 16A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8239
Mailing Address - Country:US
Mailing Address - Phone:314-251-6725
Mailing Address - Fax:314-251-6726
Practice Address - Street 1:621 S NEW BALLAS RD STE 16A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8239
Practice Address - Country:US
Practice Address - Phone:314-251-6725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty