Provider Demographics
NPI:1649203308
Name:VISIONWORKS, INC.
Entity Type:Organization
Organization Name:VISIONWORKS, INC.
Other - Org Name:VISIONWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MVC CONTRACTS & CREDENTIALING MANAG
Authorized Official - Prefix:
Authorized Official - First Name:DOLSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-524-6663
Mailing Address - Street 1:175 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2255
Mailing Address - Country:US
Mailing Address - Phone:210-524-6803
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:1004 INDEPENDENCE CENTER
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057
Practice Address - Country:US
Practice Address - Phone:816-795-0011
Practice Address - Fax:816-795-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507520005Medicaid
MO000014542Medicare PIN
MOMA2269Medicare PIN
MOS680000Medicare PIN
MOMA2270Medicare PIN
MO507520005Medicaid