Provider Demographics
NPI:1851694921
Name:VISIONQUEST EYECARE, PC
Entity Type:Organization
Organization Name:VISIONQUEST EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SKIRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-213-8131
Mailing Address - Street 1:1160 NORTH SR 135 SUITE A
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1019
Mailing Address - Country:US
Mailing Address - Phone:317-865-6829
Mailing Address - Fax:317-886-7655
Practice Address - Street 1:1160 NORTH SR 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1019
Practice Address - Country:US
Practice Address - Phone:317-865-6829
Practice Address - Fax:317-886-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003177A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200320060AMedicaid