Provider Demographics
NPI:1861681082
Name:JAMES W VANN INC
Entity Type:Organization
Organization Name:JAMES W VANN INC
Other - Org Name:VISIONARTS EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-642-6800
Mailing Address - Street 1:614 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-1983
Mailing Address - Country:US
Mailing Address - Phone:573-642-6800
Mailing Address - Fax:573-642-5707
Practice Address - Street 1:614 MARKET ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1983
Practice Address - Country:US
Practice Address - Phone:573-642-6800
Practice Address - Fax:573-642-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02653Medicare UPIN
MO0639250001Medicare NSC