Provider Demographics
NPI:1477664076
Name:VICTORIA VISION CENTER LLC
Entity Type:Organization
Organization Name:VICTORIA VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-578-0234
Mailing Address - Street 1:107 JAMES COLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3100
Mailing Address - Country:US
Mailing Address - Phone:361-578-0234
Mailing Address - Fax:361-580-3168
Practice Address - Street 1:107 JAMES COLEMAN DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3100
Practice Address - Country:US
Practice Address - Phone:361-578-0234
Practice Address - Fax:361-580-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5803730001Medicare NSC