Provider Demographics
NPI:1366639148
Name:VISION SERVICE CORPORATION
Entity Type:Organization
Organization Name:VISION SERVICE CORPORATION
Other - Org Name:EYE MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-475-0035
Mailing Address - Street 1:4810 TECUMSEH LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-3220
Mailing Address - Country:US
Mailing Address - Phone:812-475-0035
Mailing Address - Fax:812-477-4537
Practice Address - Street 1:5274 SALEM AVE
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1702
Practice Address - Country:US
Practice Address - Phone:937-837-3937
Practice Address - Fax:937-837-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4807T1649332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
INTW848670-AMedicare PIN