Provider Demographics
NPI:1609145101
Name:VISION SERVICE CORPORATION
Entity Type:Organization
Organization Name:VISION SERVICE CORPORATION
Other - Org Name:EYE MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-475-0035
Mailing Address - Street 1:4810 TECUMSEH LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-3220
Mailing Address - Country:US
Mailing Address - Phone:812-475-0035
Mailing Address - Fax:812-477-4537
Practice Address - Street 1:6614 LOGAN DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8236
Practice Address - Country:US
Practice Address - Phone:812-477-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier