Provider Demographics
NPI:1811038227
Name:VISIONMASTER, INC.
Entity type:Organization
Organization Name:VISIONMASTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAUTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-883-1029
Mailing Address - Street 1:964 AIRPORT RD SW
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1393
Mailing Address - Country:US
Mailing Address - Phone:256-883-1029
Mailing Address - Fax:256-883-7850
Practice Address - Street 1:964 AIRPORT RD SW
Practice Address - Street 2:SUITE 12
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1393
Practice Address - Country:US
Practice Address - Phone:256-883-1029
Practice Address - Fax:256-883-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51059912OtherBCBSOFAL
AL51059912OtherBCBSOFAL