Provider Demographics
NPI:1902933435
Name:VISION ASSOCIATES INC
Entity Type:Organization
Organization Name:VISION ASSOCIATES INC
Other - Org Name:VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AVALLONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-251-9095
Mailing Address - Street 1:911 TECH DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-0701
Mailing Address - Country:US
Mailing Address - Phone:318-251-9095
Mailing Address - Fax:318-251-1705
Practice Address - Street 1:911 TECH DRIVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-0701
Practice Address - Country:US
Practice Address - Phone:318-251-9095
Practice Address - Fax:318-251-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA927-032T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1346870Medicaid
LA1346870Medicaid
LA0784850001Medicare NSC
LA57362Medicare PIN