Provider Demographics
NPI:1891451001
Name:VISIONARY EYECARE OF KENSINGTON
Entity Type:Organization
Organization Name:VISIONARY EYECARE OF KENSINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-648-3786
Mailing Address - Street 1:359 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2651
Mailing Address - Country:US
Mailing Address - Phone:860-829-1020
Mailing Address - Fax:
Practice Address - Street 1:359 MAIN ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-2651
Practice Address - Country:US
Practice Address - Phone:860-829-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies