Provider Demographics
NPI:1790967966
Name:VISION CENTER OF JOHNSON COUNTY PC
Entity Type:Organization
Organization Name:VISION CENTER OF JOHNSON COUNTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-684-5501
Mailing Address - Street 1:114 W ANGUS ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1830
Mailing Address - Country:US
Mailing Address - Phone:307-684-5501
Mailing Address - Fax:307-684-5503
Practice Address - Street 1:114 W ANGUS ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1830
Practice Address - Country:US
Practice Address - Phone:307-684-5501
Practice Address - Fax:307-684-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY21672Medicare PIN
WY6074840001Medicare NSC