Provider Demographics
NPI:1013093681
Name:VISION CARE ASSOCIATES, LLC
Entity type:Organization
Organization Name:VISION CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:V
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:660-385-5724
Mailing Address - Street 1:1705 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2602
Mailing Address - Country:US
Mailing Address - Phone:660-385-5724
Mailing Address - Fax:660-385-3924
Practice Address - Street 1:1705 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2602
Practice Address - Country:US
Practice Address - Phone:660-385-5724
Practice Address - Fax:660-385-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MORS13708OtherNDCPC ID
MO535080006Medicaid
MORS13708OtherNDCPC ID
MO1158230001Medicare NSC