Provider Demographics
NPI:1205064656
Name:VISIONS OPTICAL, P.C.
Entity type:Organization
Organization Name:VISIONS OPTICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:DEWART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-432-4060
Mailing Address - Street 1:5014 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6804
Mailing Address - Country:US
Mailing Address - Phone:260-432-4060
Mailing Address - Fax:260-436-7475
Practice Address - Street 1:5014 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6804
Practice Address - Country:US
Practice Address - Phone:260-432-4060
Practice Address - Fax:260-436-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6261710001Medicare NSC
IN262270Medicare PIN