Provider Demographics
NPI:1689735250
Name:VISION CORRECTION CENTER, LLC
Entity Type:Organization
Organization Name:VISION CORRECTION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-248-0095
Mailing Address - Street 1:1406 MCFARLAND BLVD N
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2293
Mailing Address - Country:US
Mailing Address - Phone:205-248-0095
Mailing Address - Fax:205-345-9016
Practice Address - Street 1:1406 MCFARLAND BLVD N
Practice Address - Street 2:SUITE 2B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2293
Practice Address - Country:US
Practice Address - Phone:205-248-0095
Practice Address - Fax:205-345-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL01C0001041261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554568Medicaid
AL051554568Medicare PIN
AL051554568Medicaid