Provider Demographics
NPI: | 1407037252 |
---|---|
Name: | VISION CENTER AT WESTBANK, INC |
Entity Type: | Organization |
Organization Name: | VISION CENTER AT WESTBANK, INC |
Other - Org Name: | THE VISION CENTER OF JACKSON |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BONNIE |
Authorized Official - Middle Name: | CHRISTINE |
Authorized Official - Last Name: | KOVACS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 307-733-1441 |
Mailing Address - Street 1: | PO BOX 14310 |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSON |
Mailing Address - State: | WY |
Mailing Address - Zip Code: | 83002-4310 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 307-733-1441 |
Mailing Address - Fax: | 307-734-8232 |
Practice Address - Street 1: | 520 US HWY 89 |
Practice Address - Street 2: | |
Practice Address - City: | JACKSON |
Practice Address - State: | WY |
Practice Address - Zip Code: | 83001 |
Practice Address - Country: | US |
Practice Address - Phone: | 307-733-1441 |
Practice Address - Fax: | 307-734-8232 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-11-21 |
Last Update Date: | 2008-12-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WY | 243T | 332H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332H00000X | Suppliers | Eyewear Supplier |