Provider Demographics
NPI:1568819803
Name:VISION RADIOLOGY PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:VISION RADIOLOGY PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:VISION PROFESSIONAL SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MC
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-389-5711
Mailing Address - Street 1:2825 OAK LAWN AVE UNIT 192749
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4688
Mailing Address - Country:US
Mailing Address - Phone:844-389-5711
Mailing Address - Fax:877-880-2039
Practice Address - Street 1:2825 OAK LAWN AVE UNIT 192749
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4688
Practice Address - Country:US
Practice Address - Phone:844-389-5711
Practice Address - Fax:877-880-2039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISION PROFESSIONAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-17
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802416240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty