Provider Demographics
NPI:1356886360
Name:SUCCESS VISION EXPRESS OF HOT SPRINGS, LLC
Entity type:Organization
Organization Name:SUCCESS VISION EXPRESS OF HOT SPRINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-895-1700
Mailing Address - Street 1:5312 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-6110
Mailing Address - Country:US
Mailing Address - Phone:918-895-1700
Mailing Address - Fax:
Practice Address - Street 1:4043 CENTRAL AVE
Practice Address - Street 2:STE A
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7208
Practice Address - Country:US
Practice Address - Phone:501-701-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL920802332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier