Provider Demographics
NPI:1124121918
Name:VISIONCARE INCORPORATED
Entity type:Organization
Organization Name:VISIONCARE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROEDER
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:920-748-2676
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-0202
Mailing Address - Country:US
Mailing Address - Phone:920-748-2676
Mailing Address - Fax:920-748-5105
Practice Address - Street 1:113 WATSON ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1326
Practice Address - Country:US
Practice Address - Phone:920-748-2676
Practice Address - Fax:920-748-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0473740001Medicare NSC