Provider Demographics
NPI:1558629584
Name:VISIO EYECARE INC
Entity Type:Organization
Organization Name:VISIO EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NGOC
Authorized Official - Middle Name:
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-471-6245
Mailing Address - Street 1:2249 KNORR STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 1A, 1100 WASHINGTON AVE, LOT C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147
Practice Address - Country:US
Practice Address - Phone:267-471-6245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4101203305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service