Provider Demographics
NPI:1063693034
Name:VISION MASTERS, P.C.
Entity type:Organization
Organization Name:VISION MASTERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCLANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-882-3040
Mailing Address - Street 1:113 CITY SMITTY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-8908
Mailing Address - Country:US
Mailing Address - Phone:912-882-3040
Mailing Address - Fax:912-882-3786
Practice Address - Street 1:113 CITY SMITTY DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-8908
Practice Address - Country:US
Practice Address - Phone:912-882-3040
Practice Address - Fax:912-882-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00254141BMedicaid
GA959951220AMedicaid
GA00261797CMedicaid
GA00243911BMedicaid
GA00243911BMedicaid
GA0270120002Medicare NSC
GA41ZCCVVMedicare PIN
GA00261797CMedicaid
GAT84142Medicare UPIN
GA00254141BMedicaid
GA959951220AMedicaid