Provider Demographics
NPI:1528130424
Name:VISION CARE P A
Entity type:Organization
Organization Name:VISION CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-423-7229
Mailing Address - Street 1:213 WEST MAIN STREET
Mailing Address - Street 2:PO BOX 251
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536
Mailing Address - Country:US
Mailing Address - Phone:843-774-8112
Mailing Address - Fax:843-774-8115
Practice Address - Street 1:213 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3348
Practice Address - Country:US
Practice Address - Phone:843-774-8112
Practice Address - Fax:843-774-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO7892 DA9985Medicaid
SCDO7892 DA9985Medicaid