Provider Demographics
NPI:1972497287
Name:MVC VISION 01 VCS
Entity type:Organization
Organization Name:MVC VISION 01 VCS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-449-9173
Mailing Address - Street 1:6880 EP TRUE PKWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5285
Mailing Address - Country:US
Mailing Address - Phone:833-586-2020
Mailing Address - Fax:
Practice Address - Street 1:6880 EP TRUE PKWY
Practice Address - Street 2:SUITE 109
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5285
Practice Address - Country:US
Practice Address - Phone:833-586-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery