Provider Demographics
NPI:1669541751
Name:VISION TECH OPTOMETRY CENTER INC.
Entity type:Organization
Organization Name:VISION TECH OPTOMETRY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HUBERT
Authorized Official - Last Name:LEETH
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:540-949-7126
Mailing Address - Street 1:400 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3608
Mailing Address - Country:US
Mailing Address - Phone:540-949-7126
Mailing Address - Fax:540-943-6170
Practice Address - Street 1:400 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3608
Practice Address - Country:US
Practice Address - Phone:540-949-7126
Practice Address - Fax:540-943-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0310160001Medicare NSC