Provider Demographics
NPI:1639250053
Name:VISION CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:VISION CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:EGGEBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-459-9595
Mailing Address - Street 1:7750 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4174
Mailing Address - Country:US
Mailing Address - Phone:260-459-9595
Mailing Address - Fax:260-459-9494
Practice Address - Street 1:7750 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4174
Practice Address - Country:US
Practice Address - Phone:260-459-9595
Practice Address - Fax:260-459-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1273200001Medicare NSC