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
StateLicense IDTaxonomies
WY243T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier