Provider Demographics
NPI:1013015114
Name:VISION OPTICS PC
Entity Type:Organization
Organization Name:VISION OPTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROTHERMEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-792-5880
Mailing Address - Street 1:1305 SIDNEY BAKER ST STE B
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2737
Mailing Address - Country:US
Mailing Address - Phone:830-792-5880
Mailing Address - Fax:830-792-4950
Practice Address - Street 1:1305 SIDNEY BAKER ST STE B
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2737
Practice Address - Country:US
Practice Address - Phone:830-792-5880
Practice Address - Fax:830-792-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04937T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX066137301Medicaid
TX093056201Medicaid
TX80933QOtherBCBS
TX80933QOtherBCBS
TX00E09TMedicare ID - Type Unspecified