Provider Demographics
NPI:1528386208
Name:VISION ENHANCEMENT CENTER INC.
Entity Type:Organization
Organization Name:VISION ENHANCEMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:MERVYN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-822-7271
Mailing Address - Street 1:1939 NE LOOP 410
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5350
Mailing Address - Country:US
Mailing Address - Phone:210-822-7239
Mailing Address - Fax:210-822-7271
Practice Address - Street 1:1939 NE LOOP 410
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5350
Practice Address - Country:US
Practice Address - Phone:210-822-7239
Practice Address - Fax:210-822-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2564TG152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEMPLOYER IDENTIFICATION NUMBER