Provider Demographics
NPI:1669561767
Name:VISIONWORKS INC
Entity type:Organization
Organization Name:VISIONWORKS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-524-6700
Mailing Address - Street 1:PO BOX 848448
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8448
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:2825 S GLENSTONE AVE
Practice Address - Street 2:SPACE F11
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3732
Practice Address - Country:US
Practice Address - Phone:417-882-3692
Practice Address - Fax:417-882-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4852140008Medicare NSC